The Vaccine Adverse Event Reporting System (VAERS) Results Form

219 Pages·2012·1.55 MB·English

by  Dread Pirate Stella

The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
The Vaccine Adverse Event Reporting System (VAERS) Results
Percent
VAERS Events
Vaccine Type Age (of Adverse Event Description
ID Reported
1,066)
Two days post vax, pt's signs and
symptoms included near circumferential
swelling and erythema of entire upper arm
ANTHRAX VACCINE 18-29 152323- and half of forearm Some local myalgias
1 0.09%
(ANTH) years 1 and arthralgias. Pt did not report any
systemic symptoms. Pt placed on oral
prednisone, histamine blocking agents and
had resolution within 24 hours.
ANTHRAX VACCINE 18-29
Total 1 0.09%
(ANTH) years
Itchy rash on arms, trunk and upper legs.
Symptoms started one day (16 May 04).
No other symptoms reported. Member
denied, fever, dyspnea or any other S&S.
Denied any problems with first anthrax
dose. On exam several small bumps that
looked similar to heat rash were on
ANTHRAX VACCINE 30-39 222573-
1 0.09% forearm. Vaccination site slightly pink.
(ANTH) years 1
Member first noticed rash after running on
16 May. Member worked in yard on same
day as vaccine given, but was wearing
long sleeve shirt. No treatment given.
Member told if symptoms got worse or
didn't resolve to see his PCP. Symptoms
resolved in 2 weeks.
"Left arm numb 5"" below joint usually
ANTHRAX VACCINE 30-39 226585- does not radiate, sometimes when I sleep
1 0.09%
(ANTH) years 1 on it I feel it in the joint and wake unable
to feel the arm."
ANTHRAX VACCINE 30-39
Total 2 0.19%
(ANTH) years
2-3 Hours post-injection he had nausea.
ANTHRAX VACCINE 50-59 217384-
1 0.09% By day 3 post-injection, fatigue, chills, and
(ANTH) years 1
joint aches. Resolved by day 5
ANTHRAX VACCINE 50-59
Total 1 0.09%
(ANTH) years
ANTHRAX VACCINE
Total 4 0.38%
(ANTH)
DIPHTHERIA AND
TETANUS TOXOIDS
AND ACELLULAR < 6 111338- Pt recvd vax & devel 3cm area of
1 0.09%
PERTUSSIS months 1 induration @inj site & fever lasting 1 wk.
VACCINE (DTAP)
pt was falling asleep & mom went to place
DIPHTHERIA AND
in bussinet, noticed pt was not breathing,
TETANUS TOXOIDS
< 6 113696- eyes rolled back, tongue out of mouth
AND ACELLULAR 1 0.09%
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The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
< 6 113696- eyes rolled back, tongue out of mouth
AND ACELLULAR 1 0.09%
months 1 lasted 15sec;mom shouted & shook child-
PERTUSSIS
child responded seconds later repeat of
VACCINE (DTAP)
similar episode;brought to ER;
DIPHTHERIA AND
TETANUS TOXOIDS after vax pt exp very sleepy for about 24
< 6 123364-
AND ACELLULAR 1 0.09% hr, screamed inconsolably 2pm-12 mn,
months 1
PERTUSSIS slept fitfully until morn
VACCINE (DTAP)
afebrile sz;8hr p/vax parents noticed 3
sz;described-jerking all over, not
DIPHTHERIA AND
breathing, upward rolling of eyes, for
TETANUS TOXOIDS
< 6 125300- about 20 seconds;then drowsiness for
AND ACELLULAR 1 0.09%
months 1 several hr;adm to hosp-no further sz; had
PERTUSSIS
1 sz, a week later; tx w/ phenobarbitol
VACCINE (DTAP)
Annual follow-up received 9/5/00 states
that the pt has recovered.
DIPHTHERIA AND
TETANUS TOXOIDS local rxn in rt leg;red, hard lump, size of
< 6 130172-
AND ACELLULAR 1 0.09% dime;no fever;very fussy 24hr p/vax;call
months 1
PERTUSSIS to MD given APAP;seen in MD office;
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS 3hr p/vax pt has been crying since
< 6 130174-
AND ACELLULAR 1 0.09% vax;remarkably tender site rxn, erythema,
months 1
PERTUSSIS pain in lt leg;given APAP & sent home;
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS 5hr p/vax pt to MD office;has been crying
< 6 130175-
AND ACELLULAR 1 0.09% since vax;remarkably tender, site rxn,
months 1
PERTUSSIS erythema, pain in rt leg;
VACCINE (DTAP)
DIPHTHERIA AND
Fever, red, dime-sized circle on left upper
TETANUS TOXOIDS
< 6 167841- thigh at Prevnar site. Dx'd with local
AND ACELLULAR 1 0.09%
months 1 reaction to Prevnar approx. 1 cm
PERTUSSIS
diameter.
VACCINE (DTAP)
DIPHTHERIA AND Following vax, the pt experienced
TETANUS TOXOIDS sleepiness and a red injection site. The pt
< 6 168218-
AND ACELLULAR 1 0.09% was treated with Tylenol. The most recent
months 1
PERTUSSIS information received on 3/27/00 reports
VACCINE (DTAP) the condition of the pt as resolved.
On 2/15/00 the pt received her second
dose of Infanrix. Subsequently she was
sleepy for 24 hours, screamed for 4 hours
DIPHTHERIA AND
TETANUS TOXOIDS and was flaccid, had a fever the next day
AND ACELLULAR < 6 168219- and had a slightly red injection site. The pt
1 0.09%
PERTUSSIS months 1 was treated with Tylenol. Outcome
VACCINE (DTAP) resolved. The most recent information
received on 3/27/00 reports the condition
of the pt as resolved. Following the 1st
dose, the pt was lethargic, but recovered.
DIPHTHERIA AND On 12/21/99, the pt received his first dose
TETANUS TOXOIDS of Infanrix, subsequently he screamed and
< 6 168220-
AND ACELLULAR 1 0.09% was difficult to console. Additionally he had
months 1
PERTUSSIS a fever of 100.6 degrees (rectal). Outcome
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The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
PERTUSSIS a fever of 100.6 degrees (rectal). Outcome
VACCINE (DTAP) of pt is resolved.
On 12/23/99, the pt received his first dose
DIPHTHERIA AND
of Infanrix. Subsequently on 12/23/99 he
TETANUS TOXOIDS
< 6 168221- screamed for two hours. Outcome:
AND ACELLULAR 1 0.09%
months 1 resolved. The most recent information
PERTUSSIS
received on 3/27/00 reports the condition
VACCINE (DTAP)
of the pt as resolved.
DIPHTHERIA AND Following vaccination, the same day the pt
TETANUS TOXOIDS cried for 6 hours. No treatment was given.
< 6 168224-
AND ACELLULAR 1 0.09% The outcome is resolved. The most recent
months 1
PERTUSSIS information received on 3/27/00 reports
VACCINE (DTAP) the condition of the pt as resolved.
"Two hours post vax, the pt was irritable,
DIPHTHERIA AND
and screamed for nine hours. The injection
TETANUS TOXOIDS
< 6 168225- site was swollen. The next day she was
AND ACELLULAR 1 0.09%
months 1 ""out of sorts"". The most recent
PERTUSSIS
information received on 3/27/00 reported
VACCINE (DTAP)
the condition of the pt as resolved."
About 10 minutes post vax, while heavily
bundled and in infant seat, pt paled and
DIPHTHERIA AND
turned blue. He appeared apneic. He was
TETANUS TOXOIDS
< 6 178040- given blow by O2. He cried vigorously but
AND ACELLULAR 1 0.09%
months 1 appeared weak. Rescue squad was called,
PERTUSSIS
and pt was hospitalized overnight. He had
VACCINE (DTAP)
no further trouble with color after about 1
hour.
DIPHTHERIA AND
Baseball-sized area of redness and
TETANUS TOXOIDS
< 6 180181- erythema at left thigh injection site X 48
AND ACELLULAR 1 0.09%
months 1 hours; inconsolable crying and fussiness X
PERTUSSIS
over 8 hours, following injection.
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
< 6 198697-
AND ACELLULAR 1 0.09% Fever of 103 and decreased appetite
months 1
PERTUSSIS
VACCINE (DTAP)
At 2 months of age, 8/27/97, HIB #1, Hep
B #1, IVP #2, DTaP #1; 10/22/97 HIB #2,
Hep B #2, IPV #2, DTaP #2. Reacted to
immunization with fever then several
hours later convulsions. Seizures not
present prior. No improvement over
several weeks. Took child to hospital and
doctor gave 10/27/97 shots; I said no.
She did them anyway. Child died a few
months later. 8/12/03: Information
received from corrections facility where the
reporter is an inmate, indicates that he
may not receive outside phone calls but
letters are permitted. A letter of request
for ER and inpatient record was faxed for
the admission on 11/22/03. 8/14/03 This
record was received and includes: the ER
evaluation; the H&P and the Discharge
Summary w/ an addendum that includes
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The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
Summary w/ an addendum that includes
the findings from the transfer hospital
where child was hospitalized for more
extensive evaluation of abnormal head CT.
The discharge diagnosis on 11/25/97 was
DIPHTHERIA AND Failure To Thrive. The addendum which
TETANUS TOXOIDS
< 6 207692- was added after the child's transfer and
AND ACELLULAR 1 0.09%
months 1 evaluation at the higher level of care
PERTUSSIS
facility was a diagnosis of Krabbe Disease,
VACCINE (DTAP)
an autosomal recessive genetic disorder
leading to progressive demyelination of the
nervous system. As a result of this
evaluation, it was also determined that the
mother's father was also the child's father
and this man was later arrested and
arraigned on sexual assault charges. There
was no autopsy done on this patient per
Office of Chief Medical Examiner. 8/13/03
Call to PMD for this child from birth to the
time of his death, to request immunization
and relevant OV records. Since it has been
5 yrs since the death of this patient, they
have placed the records in storage. She
has agreed to locate the records and send
them to VAERS 9/3/03 Official Certificate
of Death received which confirms the
cause of death as Krabbe's Disease. A
copy of the 5 pp. Discharge Summary from
hospital is received for the admission from
11/25/97-12/02/97. The discharge
diagnosis is listed as progressive
leukodystrophy, probable Krabbe Disease.
It is not clear if or when the immu
DIPHTHERIA AND Baby was fussy, vomited had temp. 1/2
TETANUS TOXOIDS dollar sized red hard raised area on right
< 6 218237-
AND ACELLULAR 1 0.09% thigh warm to touch. Continue to give
months 1
PERTUSSIS Tylenol for temp and discomfort call if site
VACCINE (DTAP) doesn't improve.
4 hours after her shots she cried for 12
hours straight! This was not normal crying
but hard screaming. Her leg was very
DIPHTHERIA AND swollen and beat red. She developed a
TETANUS TOXOIDS rash 2 days later. Her crying continued for
< 6 251308-
AND ACELLULAR 1 0.09% a month straight, she cried all day and all
months 1
PERTUSSIS night. 24 hours after the shots she had a
VACCINE (DTAP) seizure. 3 weeks later she had an
intracranial bleed. By this time she had
about 6 seizures and the day of the bleed
she was having them every 3-6 minutes.
Also her ventricles were swollen.
irritable, fevers, non-stop crying. No bowel
DIPHTHERIA AND movements unless given laxative. After
TETANUS TOXOIDS receiving his shots this all began. Called
< 6 285519-
AND ACELLULAR 1 0.09% doctors, twice they said shots given could
months 1
PERTUSSIS not cause this and this was normal, but I
VACCINE (DTAP) went online and my son had symptoms of
site affects from Rotavirus vaccine.
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The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
site affects from Rotavirus vaccine.
Patient woke from her nap crankier than
normal; within an hour, she was
screaming inconsolably. Her legs became
red and swollen at each vaccination site.
She seemed to be running a slight fever,
DIPHTHERIA AND
but nothing over 101F. At our
TETANUS TOXOIDS
< 6 427805- pediatrician's advice, we gave her a dose
AND ACELLULAR 1 0.09%
months 1 of infant Tylenol, and applied cold
PERTUSSIS
compresses to the vaccination sites; this
VACCINE (DTAP)
eased her discomfort. We needed to
repeat the Tylenol at two more doses to
keep her from becoming extremely upset
at those times; irritability continued for
about 36 hours after the vaccination.
DIPHTHERIA AND
TETANUS TOXOIDS
< 6
AND ACELLULAR Total 22 2.06%
months
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS Several hr p/vax pt devel
6-11 111339-
AND ACELLULAR 1 0.09% screaming,ecchymosis @inj site & fever
months 1
PERTUSSIS 101.4.
VACCINE (DTAP)
DIPHTHERIA AND
local rxn, very fussy;pain @ site,
TETANUS TOXOIDS
6-11 130173- remarkable tenderness, erythema;temp
AND ACELLULAR 1 0.09%
months 1 this AM 102 ax @ home;seen in MD office
PERTUSSIS
10/20/99 3PM;rt leg reaction;
VACCINE (DTAP)
2 days, post/vax, Mom notices that when
DIPHTHERIA AND
baby is in standing position, her legs are
TETANUS TOXOIDS
6-11 133856- shaking, head is not steady. Called MD &
AND ACELLULAR 1 0.09%
months 1 was seen 2/4 w/same sxs. MD has referred
PERTUSSIS
pt to Neurologist. Mom says baby is fine
VACCINE (DTAP)
now but will f/u.
DIPHTHERIA AND
Runny nose, fever, fussy, red dime-sized
TETANUS TOXOIDS
6-11 167840- circle on left thigh at Prevnar site. Dx'd
AND ACELLULAR 1 0.09%
months 1 with URI and Prevnar reaction, approx. 1
PERTUSSIS
cm in diameter.
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
6-11 184753- 5cm inflammed/red area around injection
AND ACELLULAR 1 0.09%
months 1 site X 4 days (DTAP site). Fever X 2 days.
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND Co-worker called to state that child was
TETANUS TOXOIDS diagnosed with whooping cough. Both
6-11 462214-
AND ACELLULAR 1 0.09% mother and child placed on Zithromax and
months 1
PERTUSSIS a nasal swab was done of child on
VACCINE (DTAP) 08/15/2012.
DIPHTHERIA AND
TETANUS TOXOIDS
6-11
AND ACELLULAR Total 6 0.56%
months
PERTUSSIS
VACCINE (DTAP)
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The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
076602- onset of diffuse erythema & urticaria w/in
AND ACELLULAR 1-2 years 1 0.09%
1 30 mins of DTAP & HIB vax; rx Epi & DPH;
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
105946-
AND ACELLULAR 1-2 years 1 0.09% sterile abscess lt shoulder;
1
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
Approx 4 day p/vax pt devel walnut size
TETANUS TOXOIDS
111340- purple area @inj site,fussiness & fever of
AND ACELLULAR 1-2 years 1 0.09%
1 99.9. 12April98 pt devel nightmares. Pea
PERTUSSIS
sized lump @inj site still remains
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
111341- Approx 2 hr p/vax pt devel fever 101.3.
AND ACELLULAR 1-2 years 1 0.09%
1 Also redness & firmness @inj site.
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
117696- Pt recv vax on 12/15/98; on 12/16/98 pt
AND ACELLULAR 1-2 years 1 0.09%
1 exp fever (104.5), febrile seizure
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS Pt recv vax on 4/20/99; 15 min post vax
121471-
AND ACELLULAR 1-2 years 1 0.09% pt exp large hives on back of neck,
1
PERTUSSIS shoulders & chest; pt to E.R.; tx=Benadryl
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS 130003- erythema multiforme rash began several
AND ACELLULAR 1-2 years 1 1 0.09% hours p/vax, spread over next day,
PERTUSSIS resolved w/in a week;
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
134391- Swelling, redness, slightly tender. Gait
AND ACELLULAR 1-2 years 1 0.09%
1 normal. Afebrile.
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS 24 hours post vax, the pt developed mild
152883-
AND ACELLULAR 1-2 years 1 0.09% erythema at injection site and swelling
1
PERTUSSIS from thigh to knee.
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS Eight days, post vax, pt developed a low
156140-
AND ACELLULAR 1-2 years 1 0.09% fever and urticarial rash which spread to
1
PERTUSSIS the trunk and extremities. No treatment.
VACCINE (DTAP)
24 hours, post vax, pt came back to office
DIPHTHERIA AND
with redness and swelling of right thigh.
TETANUS TOXOIDS
158741- No fever. Pt has been cranky. Treat with
AND ACELLULAR 1-2 years 1 0.09%
1 Tylenol and Motrin and warm baths to
PERTUSSIS
decrease swelling. Cool wash cloth to area
VACCINE (DTAP)
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The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
decrease swelling. Cool wash cloth to area
VACCINE (DTAP)
of swelling. Call with any changes.
"Post vax, pt was fussy in the evening and
moaning after she went to sleep. Mom
noted legs/arms shaking, flailing but
DIPHTHERIA AND stopped with mom's touch. One arm very
TETANUS TOXOIDS cool to touch for ""awhile"". When child
164430-
AND ACELLULAR 1-2 years 1 0.09% was awakened, seemed a little dazed. Next
1
PERTUSSIS AM, was cranky but playful. Normal exam
VACCINE (DTAP) in office. Several days later developed
enteritis (suspect community acquired as
very prevalent now and sibling with
symptoms)."
DIPHTHERIA AND
The pt became fussy, experienced
TETANUS TOXOIDS
167869- increased sleeping the same day of the
AND ACELLULAR 1-2 years 1 0.09%
1 vax. The pt also experienced urticaria
PERTUSSIS
increasing over the next 24 hours.
VACCINE (DTAP)
In 2/00 the pt received her third dose of
Infanrix. Subsequently, the same day as
DIPHTHERIA AND
the vax, she screamed and had a fever
TETANUS TOXOIDS
168222- and soreness at the injection site (leg). No
AND ACELLULAR 1-2 years 1 0.09%
1 treatment was given. Outcome: resolved.
PERTUSSIS
The most recent information received on
VACCINE (DTAP)
3/27/00 reports the condition of the pt as
resolved.
On the same day of vax, the pt
DIPHTHERIA AND experienced redness and heat at the
TETANUS TOXOIDS 168223- injection site, which was 1/2/ the size of a
1-2 years 1 0.09%
AND ACELLULAR 1 softball. Outcome: resolved. The most
PERTUSSIS recent information received on 3/27/00
VACCINE (DTAP) reports the condition of the pt as resolved.
DIPHTHERIA AND
TETANUS TOXOIDS
175589- The pt experienced a red, hot raised area
AND ACELLULAR 1-2 years 1 0.09%
1 to the left mid thigh.
PERTUSSIS
VACCINE (DTAP)
On 11/08/2001 the patient's mother
DIPHTHERIA AND noticed redness, swelling and warmness.
TETANUS TOXOIDS The patient was seen by the Dr on
177850-
AND ACELLULAR 1-2 years 1 0.09% 11/09/2001 and diagnosed with erythema
1
PERTUSSIS and swelling of the left upper thigh. The
VACCINE (DTAP) patient was treated with Motrin and
Benadryl.
DIPHTHERIA AND
TETANUS TOXOIDS
181638- Pt. received vaccines on 2/18/02, swelling
AND ACELLULAR 1-2 years 1 0.09%
1 and warmth of shoulders immediately post
PERTUSSIS
VACCINE (DTAP)
"Onset a dinnertime, following with
DIPHTHERIA AND
decrease use right leg. Continued until
TETANUS TOXOIDS
194064- bedtime, No ambulating right leg, Sx
AND ACELLULAR 1-2 years 1 0.09%
1 resolved in AM. Walking fine. Remains
PERTUSSIS
asymptomatic with function. Has ""rash""
VACCINE (DTAP)
right leg injection sites"
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The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
DIPHTHERIA AND
Mother states that child's entire leg above
TETANUS TOXOIDS
201722- the knee became very swollen, red and hot
AND ACELLULAR 1-2 years 1 0.09%
1 to touch. The swelling began on the
PERTUSSIS
3/28/03 and was better 24-48 hrs later.
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS Swelling, redness, induration of right
237060-
AND ACELLULAR 1-2 years 1 0.09% upper thigh noted approx 12 hrs after
1
PERTUSSIS immunization
VACCINE (DTAP)
Information has been received from a
woman in a physician's office concerning a
9 year old female with no medical history
who on 27 MAY 1997 was vaccinated SC
with first dose of Varicella. Concomitant
vaccinations on that same day included an
IM fourth dose of TRIPEDIA. There was no
DIPHTHERIA AND illness at teh time of vaccination. It was
TETANUS TOXOIDS reported that on 10 JAN 2005 the patient's
238794-
AND ACELLULAR 1-2 years 1 0.09% mother called the physician's office
1
PERTUSSIS indicating that her daughter developed
VACCINE (DTAP) slightly itchy leasions on her chest, legs
and back and subsequenlty developed
more. As of Feb 2005 the patient was
noted to be recovering as her lesions were
in the process of scabbing. Subsequently
the patient's slightly itchy lesions resolved.
Additional information is not expected.
"Had his shots on September 6, 2005,
both in the left arm. The next day he had
swelling, rash, and bruise on at shot
location, which got progressively worse
and became significant over the next few
days. He also developed a stuffy nose that
made it difficult for him to sleep on
DIPHTHERIA AND Thursday night. The symptoms increased
TETANUS TOXOIDS on Sunday night when his breathing
244130-
AND ACELLULAR 1-2 years 1 0.09% became difficult, he was ""hitching"" and
1
PERTUSSIS grunting with each breath. We took him to
VACCINE (DTAP) the emergency rooom on 9/11/05 and his
oxygen was at 91%. He was given a
nebulizer with oxygen at 10 and when we
brought him home we gave him another
treatment at midnight. He was doing much
better the next day. On 9/14 (today) he
still has bruising, redness and soreness at
the shot site."
Woke from sleep at 8pm/screamed and
DIPHTHERIA AND cried and inconsolable x 3+ hours/ refused
TETANUS TOXOIDS all attempts at comforting / very hot and
287872-
AND ACELLULAR 1-2 years 1 0.09% sweaty and hands/arms shaking are red
1
PERTUSSIS back and went limp and fell asleep in
VACCINE (DTAP) mothers arm/ next day seemed fine, tired
and clingy.
DIPHTHERIA AND
TETANUS TOXOIDS
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The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
TETANUS TOXOIDS
341645- "Red, swollen, hard, lump ""the size of 2
AND ACELLULAR 1-2 years 1 0.09%
1 Quarters"" no c/o discomfort noted."
PERTUSSIS
VACCINE (DTAP)
Mother reports 8 hrs. following
DIPHTHERIA AND immunizations that pt. was sleepy with
TETANUS TOXOIDS rolling eyes and sticking her tongue out,
420121-
AND ACELLULAR 1-2 years 1 0.09% along with fever. The next night pt. had
1
PERTUSSIS leg up in the air and mother had difficult
VACCINE (DTAP) time pulling it down. (Mother did give
Acetaminophen the first night).
DIPHTHERIA AND
TETANUS TOXOIDS Left thigh, red, hard, hot area - increased
445675-
AND ACELLULAR 1-2 years 1 0.09% in size past 24 hours, painful, fever.
1
PERTUSSIS Started on ABX TMP/SMZ.
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
AND ACELLULAR 1-2 years Total 27 2.53%
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
099183-
AND ACELLULAR 3-5 years 1 0.09% hives-itchy, SOB, genital swelling;
1
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS erythema, edema entire arm & shoulder-
110769-
AND ACELLULAR 3-5 years 1 0.09% elbow w/extensive erythema to chest &
1
PERTUSSIS forearm approx 36hr p/vax;
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
175571- 6 x 9 inch irregular shaped red, swollen
AND ACELLULAR 3-5 years 1 0.09%
1 area right upper arm.
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
Pink, swollen approx 6cm diameter non
TETANUS TOXOIDS
186926- tender 1-2 days after DTaP and IPV
AND ACELLULAR 3-5 years 1 0.09%
1 injection . Reactive lesion right deltoid
PERTUSSIS
area.
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
186997- Local redness and swelling on right upper
AND ACELLULAR 3-5 years 1 0.09%
1 outer thigh.
PERTUSSIS
VACCINE (DTAP)
7/31/02 received DTaP/IPV L arm. 8/1/02
pc to office report red-swollen L arm,
DIPHTHERIA AND warm to touch, afebrile, support RN. 8/2
TETANUS TOXOIDS office visit, very swollen L arm red approx.
189103-
AND ACELLULAR 3-5 years 1 0.09% 20 tiny blisters at mid deltoid. Active,
1
PERTUSSIS mildly tender. Begun on Keflex to R/O
VACCINE (DTAP) infection, Bendaryl po. 8/3 pc nl appetite,
afebrile, not worse. 8/4 pc arm better. MD
doubt infection.
DIPHTHERIA AND
Day 2 after injection. LA with itch,
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The Vaccine Adverse Event Reporting System (VAERS) Results Form 11/28/12 1:10 PM
Day 2 after injection. LA with itch,
TETANUS TOXOIDS
195623- redness, and warmth. These Sx went away
AND ACELLULAR 3-5 years 1 0.09%
1 gradually but returned today 12/27, 9
PERTUSSIS
days after injection.
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS Swelling, redness, tenderness at site of
207792-
AND ACELLULAR 3-5 years 1 0.09% injection 7 x 10 cm size (left arm-site of
1
PERTUSSIS DTaP).
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS Left arm had a small 1/2 dime size area
208718-
AND ACELLULAR 3-5 years 1 0.09% that was hard. No redness, no swelling and
1
PERTUSSIS no pain. Have mother continue to monitor.
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS Left upper arm red and warm to touch
AND ACELLULAR 3-5 years 208729- 1 0.09% near injection site. 2+ edema. Continue to
PERTUSSIS 1 monitor. Give Benadryl and Tylenol.
VACCINE (DTAP)
DIPHTHERIA AND
TETANUS TOXOIDS
210311-
AND ACELLULAR 3-5 years 1 0.09% Cellulitis-reaction with keflex
1
PERTUSSIS
VACCINE (DTAP)
DIPHTHERIA AND
Left arm red and hot by night after shot.
TETANUS TOXOIDS
218227- Today arm is still red, but half of arm is
AND ACELLULAR 3-5 years 1 0.09%
1 hot around the shoulder. Pain when he
PERTUSSIS
moves but is not really bad.
VACCINE (DTAP)
Patient received 5 year old immunizations
on 4/21/04. Patient received DTaP only in
DIPHTHERIA AND
left arm. Patient was seen on 4/23/04 for
TETANUS TOXOIDS
220197- cellulitis left arm and was prescribed
AND ACELLULAR 3-5 years 1 0.09%
1 antibiotic course. Nurse follow up on
PERTUSSIS
05/18/04 states: ADD: MMR # 2, Merck,
VACCINE (DTAP)
Lot # 0138N, RA; IPV # 4, Aventis, Lot #
W0334, RA.
Right shoulder hot, red, swollen 2 inches
down from top of shoulder, itchy, T 99.8
DIPHTHERIA AND
Advised cool packs, Benadryl, call if not
TETANUS TOXOIDS
223975- improving. 7/13: seen in office in
AND ACELLULAR 3-5 years 1 0.09%
1 afternoon, now with decreased energy,
PERTUSSIS
continued Tylenol, Benadryl, 7/14: flu in
VACCINE (DTAP)
office, acting more himself, mild erythema,
swelling from deltoid to elbow. No fever.
Office has seen 2 other kids in past exp
with rxn. Mom called 2 days after receiving
DIPHTHERIA AND
DTaP reports 4x4 area red warm, swollen
TETANUS TOXOIDS
224107- on arm where DTaP given. Mom describes
AND ACELLULAR 3-5 years 1 0.09%
1 much more significant after 48hours. Mom
PERTUSSIS
to given ASA med prn, Benadryl and cool
VACCINE (DTAP)
compresses. Care with significant changes
or further concerns.
DIPHTHERIA AND
TETANUS TOXOIDS
226017- Right shoulder is pink, hot, swollen and
AND ACELLULAR 3-5 years 1 0.09%
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