VAERS_ID RECVDATE STATE AGE_YRS CAGE_YR CAGE_MO SEX RPT_DATE SYMPTOM_TEXT DIED DATEDIED L_THREAT ER_VISIT HOSPITAL HOSPDAYS X_STAY DISABLE RECOVD VAX_DATE ONSET_DATE NUMDAYS LAB_DATA V_ADMINBY V_FUNDBY OTHER_MEDS CUR_ILL HISTORY PRIOR_VAX SPLTTYPE

69979 01/03/1995 AR 0.04 0 .4 F 11/09/1994 pt recvd vax; approx 1 hr later, started shaking,felt cold,mottled appearing; t102.9; pulse ox 71%; to er CXR 21oct; RML infiltrate not present 10/19; Y Y 5 Y 10/19/1994 10/19/1994 0 WBC=22,000,platelets=575;CSF culture neg;cell ct 3WBC 2RBC,glucose 60 protein 21, CO2 dec; PUB PUB apap no birth defects/allergies/viral URI; AR94107

69980 01/03/1995 AZ 1.01 1 .1 F 12/20/1994 pt recvd vax;7dec fever 103 in eve of vax;12dec fever 103.5,rash from chest to butt x 2 days;16dec fever 104.5 highest,signs of joint pain;18dec maculopapular rash neck to buttocks; Y 12/07/1994 12/12/1994 5 none PUB PUB none none none AZ9438

69981 01/03/1995 NY 1.01 1 .1 M pt recvd vax; 6nov-8nov viral pertussis; to er; exanthem 9:15pm;fever 100.9;rash;generalized adenopathy;wheezing/asthma; Y 3 Y 11/04/1994 11/06/1994 2 PVT UNK cough, wheezing none BA94029K

69982 01/03/1995 NY 64.05.00 64 M 12/05/1994 pt recvd vax; has pain in the shoulder, lt elbow & arm; arm was very red;to MD who said pt had pre-existing condition on elbow a/ & lt shoulder;x-rays done; Y 11/17/1994 11/28/1994 11 x-rays PUB PUB na na lt elbow arthritis/lt shoulder bursitis none BA94M030

69983 01/03/1995 CO 1.06 1 .6 F 11/21/1994 pt recvd vax; inc t & fussiness 2-12 hrs p/ vax;by next am t 103.5,legs & foot were swollen & very sensitive; wheezy cough, very lethargic;had apap q 4-5 hrs prior & p/; started dph next day; Y Y 11/15/1994 11/16/1994 1 PUB PUB none asthma, allergies: milk/whey, ?eggs in pt, rash w/ doses 1 & 2 DTP CO94079

69984 01/03/1995 CO 0.06 0 .6 F 12/06/1994 pt recvd vax; to er w/ URI sxs & died on 27nov; obituary did follow; final dx streptococcal epiglottitis; lung biopsy demonstrated possible H influenza; Y 11/28/1994 N 11/16/1994 11/25/1994 9 PUB PUB unk CO94080

69985 01/03/1995 FL 26.04.00 26 F 12/23/1994 pt recvd vax;noted swelling & stiffness of rt jaw;low grade fever; body aches & some difficulty talking & chewing;began 8pm same day as vax; Y 12/20/1994 12/20/1994 0 PUB PUB none none none none FL9496

69986 01/03/1995 IL 2.03 2 .3 M 11/30/1994 pt recvd vax; tues 2am started fever & rt arm started to swell;at 1pm tues fever 106 & at that time had convuls; adm to hosp; Y 1 U 11/27/1994 11/28/1994 1 blood count & cultures; PUB PUB none asthma na IL940148

69987 01/03/1995 LA 0.02 0 .2 F 12/21/1994 pt recvd vax;mom reported pt had been screaming x 20 mins;high pitch cry;advised to see MD;to er;motrin given;was told to cont cool compresses & apap,advil;mom states crying cont till 5pm;no problems p/that;highest t was 99.3 per mom; Y Y 12/21/1994 12/21/1994 0 none PUB UNK none none na LA941206

69988 01/03/1995 LA 0.02 0 .2 F 12/23/1994 pt recvd vax;mo reportes episodes of unusual crying lasting approx 4 hrs;saw er MD just as episode finishing,found no problems; Y Y 12/22/1994 12/22/1994 0 none PVT PVT none none none none LA941207

69989 01/03/1995 MA 70.08.00 70 F 12/20/1994 pt recvd vax;exp sore arm same day as vax; felt irritable & "flip floppy"; 1 wk later;rash on neck,shoulders,hair,arms & itchy all over;8 days later eye became pink & stuffy; saw MD who said flu shot rxn; Y 11/14/1994 11/14/1994 0 none PUB PUB unk none none MA9451

69990 01/03/1995 MA 30.03.00 30 F 12/19/1994 pt recvd vax;redness at site at lt deltoid muscle p/ 11 days; felt nauseous but no fever p/ shot;apap 2 days later; Y 12/08/1994 12/18/1994 10 none PUB PUB BCP none none none MA9452

69991 01/03/1995 NJ 1.04 1 .4 F 12/16/1994 pt recvd vax; devel fine rash on back on 9dec,lasted 3 days,12dec devel t 101 relieved by apap;fever lasted x 3 days;13dec devel rhinorrhea;was irritable but consolable; emesed 2 x;exp loss of appetite;if sxs persist,see MD again; U 12/01/1994 12/02/1994 1 none PUB PUB none ?allergies to lactose;pt is taking reg milk now; NJ9473

69992 01/03/1995 NM 0.01 0 .1 F 12/14/1994 pt recvd vax; unconssolable screaming cry p/ dtp > 4 hrs; no tx needed Y Y 12/01/1994 12/01/1994 0 none PUB PUB none recovered from group B strep sepsis,well none NM94017

69993 01/03/1995 OH 0.02 0 .2 M 12/14/1994 pt recvd vax; SIDS death; no sxs in the wk prior to death according to ofc; parent just found baby; Y 12/08/1994 N 12/01/1994 12/08/1994 7 autopsy performed PUB PUB OH94130

69994 01/03/1995 OH 0.02 0 .2 F 12/19/1994 pt recvd vax; screaming; unable to settle thru nite; fever approx 102 ax; took about 3 days to return to nl activities; Y 10/25/1994 10/25/1994 0 none PUB PUB none none none none OH94131

69995 01/03/1995 AZ 67.09.00 67 F 12/08/1994 pt recvd vax; pt's daughter reported, pt adm to hosp 1 wk later w/ dx of GBS; Y Y Y 10/17/1994 10/18/1994 1 UNK UNK asthma, lupus

69996 01/03/1995 LA 55.02.00 55 F 12/20/1994 pt recvd vax; dx w/ GBS;adm to hosp x 2 wks;recovering well;apparently no long term effects;no certainty that flu vax was the culprit Y Y Y 14 Y 10/12/1994 10/26/1994 14 PUB PVT unk unk unk

69997 01/03/1995 VA 60.00.00 60 M 12/23/1994 pt recvd vax; adm to hosp 9dec w/ weakness in legs;tx for GBS w/ IV IgG,complete recovery; Y 6 Y 09/09/1994 12/09/1994 91 CBC ,SMA 18, T4 TSH Mg, aldolose, sed rate all were WNL; PVT PVT inderal, cardizem, pravachol hypertension,coronary disease hypertension, coronary disease

69998 01/03/1995 CA 1.06 1 .6 F 12/21/1994 pt recvd vax;had generalized tonic clonic sz,lasting less than 5 min & resolved w/out meds;t of 104.9 & otitis med;later that noc, another sz; past hx of febrile sz 30-sep-94; father also h/o febrile sz; Y 12/21/1994 12/21/1994 0 CBC, LP, UA PUB PUB amoxicillin otitis media; pt born at 32 wks gest;twin;febrile sz 30sep94 none CA94170

69999 01/03/1995 KS 0.02 0 .2 F 12/22/1994 pt recvd vax; sz activity lasting approx 10 mins; Y Y 12/20/1994 12/20/1994 0 PVT PVT none none

70000 01/03/1995 WI 44.02.00 44 F 12/30/1994 pt recvd vax; soreness into lt wrist; next day reddened & erythema approx 10 cm in diam;appears to be cellulitic;poss mycoplasma infect,bronchitis;local rxn to pneumovax;upper resp infect;;vesicular eruption;bronchitis;sore throat,migraine Y Y 10/12/1994 10/12/1994 0 PVT PVT

70001 01/03/1995 24.00.00 24 M 12/21/1994 React Uneval Y Y 12/19/1994 12/19/1994 0 MIL MIL excedrin none none

70002 01/03/1995 DC 55.00.00 54 M 12/27/1994 pt recvd vax;3-4 days later devel ache in groin,general aches & pains,low grade t;all exams w/in nl limits;referred to urologist since sxs persist; Y N 11/03/1994 11/07/1994 4 blood chemistry,PSA, CBC,urinalysis,X-ray,CT scan of spine,abdo,flexible sigmoidoscopy; OTH PUB calan none borderline hypertension

70003 01/03/1995 WA 0.03 0 .3 M 12/29/1994 pt recvd vax;inconsolable crying,lasting 30 hrs w/ break of 4 hrs of sleep;began 3 hrs after dose given;not high pitched cry,no shock like state;no fever;recovered on 19dec by 11am; Y Y 12/27/1994 12/27/1994 0 PVT UNK none none none

70004 01/03/1995 IA 0.03 0 .3 M 12/22/1994 pt recvd vax; 3 hrs later, eyes became hazy;tongue was on roof of mouth; v x 1; lethargic x 10-20 mins; Y 12/16/1994 12/16/1994 0 none PVT PVT none none none

70005 01/03/1995 CA 0.03 0 .3 M 12/21/1994 pt recvd vax; 19dec seen in clinic; appetite dec, 1/3 of nl; watery stools x 24; inc flatus; pulling ears; Y 12/15/1994 12/17/1994 2 none PVT PVT none none heart murmur; prob hemodynamically;

70006 01/03/1995 64.09.00 64 F pt recvd vax;c/o tremors,movement dis;shaky;incordination,somewhat lightheaded w/in couple of wks p/vax;difficulty ambulating,poor balance;some n,no fever,chills or sxs suggesting viral illness;feels weak all over;cholesterol=278;bil=1.1; Y 11/03/1994 11/05/1994 2 no oth lab abnl x/ ANA 1:160,CT head scan nl;cholesterol=278;bil=1.1;BUN & serum electrolytes nl;white blood count=8150 w/ hemglobin of 14.8 & 363,000 platelets;Monocytes=9.1%;EKG showed sinus rythm;UNK UNK dyazide, thyroid hypothyroidism, hypertension

70009 01/04/1995 FL 0.05 0 .5 F 12/14/1994 pt recvd vax;t & fever of 105 R on & off from 6pm to 5am screaming all noc long, crying all noc & next day; gave warm bath all next day;very pale & stopped eating x 12 hrs;to MD 2x's next days; Y Y U 11/28/1994 11/28/1994 0 PUB PUB none none premature baby,low birth weight;had heart murmur; unk FL94099

70010 01/04/1995 RI 46.06.00 46 M 12/21/1994 pt recvd vax; reemergence of Reiter's synd 1 wk p/vax; also GBS; Y Y 11/02/1994 11/09/1994 7 PVT PVT none allergies,asthma,Reiters; none

70011 01/04/1995 FL 0.05 0 .5 M 12/21/1994 pt recvd vaxpt not responsive upon arrival at hosp; found in crib wrapped in blanket,not breathing;unable to rescuscitate;coroners case, pending autopsy report; Y 12/21/1994 N 12/19/1994 12/21/1994 2 none PVT PVT none none none none

70012 01/04/1995 AZ 0.02 0 .2 M 10/28/1994 pt recvd vax; fussiness began w/ 1st dtp,hib & opv;was adm to hosp 2 days later w/ hypernatremic dehydration; 10% weight loss; high fever 105.1; mild pneumonia & ROM; Y Y 08/31/1994 08/31/1994 0 na # 157,BUN 28, WBC 13.8,w/ 21S,8B,55L,12M; blood & stool culture neg; bicarb 15 PVT PUB none no prenatal care; 35 wks premature, PROM, TTN none

70013 01/04/1995 TX 4.01 4 M 12/27/1994 pt recvd vax; mom states fever of 105;not responding to apap;to er & given rectal suppsitory & popsicles;t return to nl;pt taken home;no oth problems; Y Y 11/14/1994 11/15/1994 1 none; refused by PAR PUB PUB none TX94538

70014 01/04/1995 MA 56.00.00 55 M 12/28/1994 pt recvd vax; sore throat, fever 102 x 4 days; chills, aches, ha; events lasted x 3 wks;bed rest, fluids, vitamin C daily Y U 11/01/1994 12/07/1994 36 throat culture taken, results neg; PUB OTH na na na

70015 01/04/1995 MA 37.05.00 37 F 12/29/1994 pt recvd vax; 24 hrs later,felt achy,low grade t;30 hrs p/ shot devel high fever, severe aches; cold sx; n; sl red rash chest; Y Y 11/03/1994 11/04/1994 1 none UNK UNK lo-ovral, deconsal-la, maxair & aerobid inhaler; none natural sources, asthma; reactive hypoglycemia none

70016 01/04/1995 WI 53.02.00 53 F 12/28/1994 pt recvd vax;26nov started w/ arthralgia,macular rash over trunk; adenopathy,lasted 7-10 days;appearance of rubella; Y Y 11/15/1994 11/26/1994 11 rubella titer neg a/ immun; PVT PVT none

70017 01/04/1995 IL 35.06.00 35 F 11/23/1994 pt recvd vax;broke out in hives eve of inject;to MD,was given a kenalog inject & po atarax;sxs persistant;back to MD again;was given medrol dose pk pf prednisone;this drug effective p/ 2nd dose Y Y 11/01/1994 11/01/1994 0 OTH OTH none none

70018 01/04/1995 MN 45.05.00 45 F 12/28/1994 pt recvd vax;devel severe h/a 12 hrs post inject x 2 days despite advil post inject; Y 06/07/1994 06/07/1994 0 none PUB PUB none none no known conditions; in pt, secs p/ vax,ha & vertigo x 2 days w/ hep B vax dose 2

70019 01/04/1995 MN 1.08 1 .8 M 12/27/1994 pt recvd vax; fever 101 by 3:30pm; given apap; by next day, only sl fever; won/t stand on leg & must be careful lifting pt; Y 12/21/1994 12/21/1994 0 PUB PUB amoxicillin resolving ear infect MN94050

70020 01/04/1995 TN 0.03 0 .3 M 12/16/1994 pt recvd vax; screaming 4-5 hrs,same day as shot; swollen leg Y 09/09/1994 09/09/1994 0 PVT PUB

70021 01/04/1995 SC 14.08 14 M 12/27/1994 pt recvd vax; 24 hrs later fever 101;shaking of hands & feet;tingling sensation;weakness,inability to walk;unable to grasp w/ hands;polyneuroparhy;aches ; no ha,no v,no d;no URI;DTR ok;slow recovering over a period of 6 wks w/ 90%return; Y Y 11/07/1994 11/08/1994 1 CPK 119, ok PVT PVT none none resp allergies; attention deficit disorder none

70022 01/04/1995 WI 28.01.00 28 F 12/20/1994 pt recvd vax; lymphadenopathy; swelling lt axilla Y 12/13/1994 12/13/1994 0 PVT PVT none none

70023 01/04/1995 CA 0.08 0 .8 M 12/19/1994 pt recvd vax; 30 mins later devel fever 105.8; shivering w/ convuls lasting 3 mins;evaluated by paramedics; Y 12/19/1994 12/19/1994 0 PVT PVT viral URI resolving none

70024 01/04/1995 GA 2.00 1 1 F 12/27/1994 pt recvd vax; t of 105; Y 11/07/1994 11/07/1994 0 na PVT PVT mild bronchitis na

70025 01/04/1995 OH 0.06 0 .6 U pt recvd vax; persistent high pitch cry w/ inc t of 104; cry was "sick" Y 12/22/1994 12/22/1994 0 none PVT PVT none none none

70026 01/04/1995 WI 30.05.00 30 M 12/30/1994 pt recvd vax;reported significant soreness;swelling at inject site for approx 1 day p/ inject;PC 8 days later & was still having pain & soreness in lt shoulder;lt upper back pain; Y 12/20/1994 12/20/1994 0 PVT PVT none acute pharyngitis 1980 splenectomy due to rupture from trauma; none

70027 01/04/1995 CA 0.02 0 .2 F 12/23/1994 pt recvd vax; torticulus; CT scan done nl; is resolving; Y 12/19/1994 12/21/1994 2 CT scan PVT PVT none none

70028 01/05/1995 MD 0.04 0 .4 M 12/07/1994 t103.1, steady, screaming, high pitched @ times; max 45mins @ a time for 3 days p/bax; Y U 11/29/1994 11/29/1994 0 PVT PVT NONE NONE NONE NONE MD94048

70029 01/05/1995 NJ 48.01.00 48 M 12/27/1994 double vision & visual distrubances; confused; paranoia; ataxia; creutzfeldt-Jakob; since admission pt become unresponsive w/random knee jerks & is in a stupor; dx encephalopathy (post-vax?) & r/o Creutzfeldt-Jakob disease; Y Y Y Y Y N 10/27/1994 11/14/1994 18 EEG constant discharge PUB PUB NONE Healthy NONE unk NJ9474

70031 01/05/1995 VA 0.02 0 .2 M 12/27/1994 screaming, unconsolable for 5 hrs refused to feed; very irritable-gave APAP during day, given Ibuprofen in ER; Y Y 12/13/1994 12/13/1994 0 NONE PVT PVT NONE healthy newborn jaundice-resolved; NA

70032 01/05/1995 CT 59.03.00 59 M 12/22/1994 Guillain-Barre Synd Y N 10/01/1994 10/24/1994 23 EMG, Lumbar Puncture c/w GBS UNK UNK

70033 01/06/1995 66.05.00 66 M 10/26/1994 Pt recvd vax & exp anxiety, h/a, stiff neck, burning upset stomach, insomnia, heard a pulse in ears, skin felt creepy 2-3 hrs p/vax; IGG was lowered unable to fend off infections; Intraocular pressure 14 on 15AUG93 & 26 on 20OCT93 10/19/1993 10/20/1993 1 13DEC93 IGG 553 abn; IGE 126 nl; UNK UNK Tenormin, Timoptic, APAP, Oxazepam, Bellergal, Esgic Hypertension, Myocardial infarction, Glaucoma, Allergy to ASA, Iridotomay both eyes; Dyshidrotic eczema

70034 01/06/1995 F 10/26/1994 pt recvd vax & exp black & blue marks, red stripes, & an indentation @ the inject site on the buttock; pt also exp pain @ the inject site described as a pinching & pulling feeling; area of atrophy @ the inject site measures 4cm in length; 10/01/1992 unk UNK UNK Kenalog dermatoses

70035 01/06/1995 NJ 85.09.00 85 M 12/14/1994 pt recvd vax 27OCT94 & was admitted to the hosp for treatmnet of thrombocytopenia; pt is currently in the ICU, receiving steroids, gamma globulin & plasmapheresis; Y Y 9 N 09/28/1994 12/10/1994 73 Platelt count 1,000/cumm; PVT PVT unspecified antihypertensive; NONE Hx of hypertension; 894350003S

70036 01/06/1995 OR M 12/07/1994 pt recvd fluv vax & 2 wks later pt suffered myocardial infarction w/subsequent development of ventricular fibrillation; pt required mechanical ventilation for approx 10 days; Y 21 U OTH OTH unk unk Pt has hx of diabetes & myocardial infarction; 894346002S

70037 01/06/1995 OR F 12/07/1994 pt recvd vax & devel pneumonia which led to resp failure; pt was intubated & mechanically ventialated for about 10 days; pt is now in a rehabilitation center; Y 30 U PVT OTH unk unk 894346003S

70039 01/06/1995 TN 0.04 0 .4 M 12/19/1994 sharp cry, would not sleep for 12 hrs; parent treated w/APAP-t99.7 Y Y 12/16/1994 12/16/1994 0 PUB PUB TN94165

70040 01/06/1995 VA 36.00.00 F 12/29/1994 pt returned to show rt arm, had scabs over area of immunization (Hep B); pt adm to scratching area; scab 1/2" long by 1/4" wide; area was clena but looked like poss impetigo; Pt was told to see MD; Y Y No lab test done PUB PUB NONE sunburn & arm peeling VA94090

70041 01/06/1995 VA 26.09.00 26 F 12/09/1994 arm sore 10 mins p/shot, numbness began in neck & spread down lt side-some dizziness-tingling-pt was told to see MD according to pts husbant-did not see a MD; Y 12/08/1994 12/08/1994 0 PUB PUB NONE NONE VA94091

70042 01/06/1995 26.08.00 26 M pt came to hosp 8DEC94 c/o sweating, shoulder pain & dizziness p/vax on 7DEC94; pt 4th & 5th fingers numb & severe pain & swelling of lt arm; c/o t103 & chills; pt appears septic & t101.7; lt arm cellulitis; WBC 27.6; sed 31; tx ATB, APAP Y 4 Y 12/07/1994 12/07/1994 0 WBC 27.6, Sed 31 PVT PVT Allopurinol, Metocloframide, Cimetidine, Limbitrol, MVI, alpha interferon; chronic myelocytic leukemia; allergies-PCN, raw carrots, natural peas; bilat testicular pain & swelling assoc w/stomach pain lt shoulder surgery secondary to dislocation; lt thigh ulcer

70043 01/06/1995 PA 0.06 0 .6 M 01/03/1995 hypotonic react-floppy baby Y Y 12/29/1994 12/29/1994 0 PVT PVT NONE NONE

70044 01/06/1995 IL 5.07 5 M 01/04/1995 fever to 103 from 18DEC-21DEC no local react; vomiting mild 19DEC inc on 21DEC; 22DEC adm for IV fluids, 20 min tonic generalized sz; 23DEC94 responded to Ativan & dilantin; No fever; Y 3 Y 12/17/1994 12/23/1994 6 CAT Scan revealed enlarged ventricles& poss A/V malformation in cerebellum PVT PVT presumed sturge-weber type synd w/hydrocephalis-stable;

70045 01/06/1995 VA 2.05 2 .5 F 10/28/1994 pt recvd vax 10OCT94 evening of 10OCT94 pt devel erythema, swelling & raised pruritic annular eruption which progressed to generalized erythematous maculopapular eruption involving chest, abdo, back & proximal extrem; Y Y 10/10/1994 10/10/1994 0 NONE PVT PVT NONE NONE NONE NONE

70046 01/06/1995 IA 0.02 0 .2 F 12/30/1994 crying, irritable, swollen quadriceps area, red, warm w/crying suspect breath holding U 12/30/1994 12/30/1994 0 PVT PVT NONE NONE NA

70047 01/06/1995 WA 4.07 4 F 12/22/1994 pt recvd vax 20DEC94 & devel fever 1st day & tender redness of rt upper arm distal to inject site over next 2d; tx w/cold compresss, APAP, DPH; eval clinic 22DEC94 sx resolved x 2d arm-nl by 24DEC94; Y 12/20/1994 12/21/1994 1 NA PVT PUB NA NONE NA NA

70231 01/09/1995 NY 64.09.00 64 F 01/03/1995 pt recvd vax;hands mildly shaky 3 days p/vax;mild incoordination,somewhat lightheaded;difficulty ambulating,poor balance;vision began to change;opsoclonus w/ irregular mvmt of arms & legs;small high brain stem lesion associated w/ myoclonus Y Y N 11/03/1994 11/06/1994 3 PVT UNK dyazide, thyroid med none hypertension, thyroidectomy in 1973 CO5758

70233 01/09/1995 KY 53.00.00 F 12/23/1994 pt recvd vax;3 days later,exp eye redness,blurred vision,rash,achy joints,stiff neck;has been told that her visions stem from vax,damage to lower lt field of eye & blurred vision is permanent;further vax seems doubtful; Y Y 2 Y N 10/28/1994 10/30/1994 2 OTH OTH synthroid,premarin,dyazide; 940119431

70234 01/09/1995 VA 38.01.00 38 F 01/04/1995 pt recvd vax;subsequently devel thrombocytopenia & vaginal bleeding which required er tx;recvd platelet transfus,blood transfus.high dose steroids;lab tests revealed neg platelet antibody & bone marrow aspiration,biopsy exams neg; Y Y Y 07/29/1994 platelet antibody neg, bone marrow biopsy neg; PVT PVT actifed, apap WAES94120617

70235 01/09/1995 PA 87.00.00 F 12/15/1994 pt recvd vax;shortly thereafter, exp memory loss; saw MD who dx dementia & alzheimer's disease; U OTH OTH zoloft none 894350002S

70236 01/09/1995 AR 0.03 0 .3 M 12/07/1994 pt recvd vax;t of 103.5 R; unconsolable crying x 6 hrs; high pitched cry; to er at 1am; no tx, changed formula; Y Y 10/05/1994 10/05/1994 0 PUB UNK none AR951

70237 01/09/1995 NY 0.02 M 09/14/1994 eye (very weak lt) motor skill weak; pt holds breath until turns purple & faint;not vax rxn per MD;mom does not want pt to recv immun for religious reason; U 06/17/1993 UNK UNK BA94MO19

70238 01/09/1995 NY 24.00.00 M 11/18/1994 pt recvd vax;c/o throat tightness; generalized itching w/ hives;epi given; examined at hlth facility Y Y 11/16/1994 11/16/1994 0 OTH UNK BA94M027

70239 01/09/1995 NY 0.04 0 .4 M 12/28/1994 pt recvd vax;5 episodes of paleness,dark lips & perspiration occured at 1:30pm & noc 9dec & 10am 10dec;recvd phenobarbital at hosp on 10dec for prophylaxis of possible sz; Y 4 Y 12/09/1994 12/09/1994 0 EEG & MRI both WNL; OTH PUB none mild atopic dermatitis none BA94M025

70240 01/09/1995 CA 64.05.00 64 F 12/15/1994 pt recvd vax;began to exp n & v along w/ sxs of the flu;sxs cont until death;pt did not seek med help;cause of death cardiac tamponade due to ruptured myocardial infarction & coronary atherosclerosis; Y 12/04/1994 N 11/10/1994 11/17/1994 7 PUB PUB unk none unk CA94160

70241 01/09/1995 CA 78.08.00 78 M 11/14/1994 pt recvd vax;sneezing,eyes burning,sore throat,trouble breathing;diaphoretic;chest pain;anxiety;BP 184/94;P=96;anaphylaxis;exacerbation of obstructive pulmonary disease;;fever,runny nose;nonspecific st abnormality;abnl ECG Y Y 4 Y 11/09/1994 11/09/1994 0 abnl ECG;non specific ST abnl PUB PUB nitro-PRN; has been seeing heart MD hx of chronic obstructive pulmonary disease;coronary artery disease & cardiacc dysrhythmias; in pt,rxn to flu shot before,achy body, w/ flu vax; CA94161

70242 01/09/1995 CA 44.03.00 44 F 11/28/1994 pt recvd vax;5 hrs later,severe chills;v;diarrhea & some constriction of her throat,lasted x 6 hrs;next day was weak;has recvd vax x last 5 yrs & has had no rxn before;pt states felt great before shot given; Y 11/23/1994 11/23/1994 0 none PUB PUB none none none none CA94162

70243 01/09/1995 CA 68.07.00 68 F 11/17/1994 pt recvd vax;mild ha; body aching,legs worse Y 10/18/1994 10/18/1994 0 none PUB PUB none none has two slipped discs-lumbar CA94163

70244 01/09/1995 CA 1.02 1 .2 M 12/28/1994 pt recvd vax; macular papular rash, chest, face; U 12/16/1994 12/26/1994 10 OTH OTH pcn; CA94164

70245 01/09/1995 CA 0.01 0 .1 M pt recvd vax;6 hrs later pt became extremely pale,bluish around mouth x 5-10 mins;not related to fever,sz, on apnea;saw ems crew w/o intervention ,regained nl coloring; 12/14/1994 12/14/1994 0 PVT PUB none none none CA94165

70246 01/09/1995 CA 69.06.00 69 M 12/01/1994 pt recvd vax;had chilly sensation,mild body malaise following day;22nov94 feeling numbness on upper lip w/ mild difficulty in swallowing;got worse next day;unable to swallow solid food;to MD 28nov;tx reglan syrup; referred to ENT Y 11/10/1994 11/22/1994 12 OTH PUB none none none CA94166

70247 01/09/1995 CA 81.02.00 81 F 12/08/1994 pt recvd vax;tightness in throat,t 99-100;some sneezing;to MD who dx viral infection & prescribed amantadine;cough non productive;some body aches,weakness;transient mild laryngitis;MD felt illness not related to vax;8dec well but hoarseness Y Y 10/25/1994 10/30/1994 5 OTH PUB tenormin, ativan none cardiac arrythmia; "nervousness" none CA94167

70248 01/09/1995 CA 61.03.00 61 F 12/03/1994 pt recvd vax;that noc,exp fever;local rxn to vax;bruising & induration lt deltoid;no cellulitis on lt deltoid;no redness Y 11/28/1994 11/28/1994 0 exam, pos brusing,fading; PUB PUB milanta, anusol, chlortrimeton hemorrhoids, gastritis na na CA94168

70249 01/09/1995 CA 1.01 1 .1 F 12/06/1994 pt returning home from clinic pt mom stated that pt felt warm & was given APAP 9PM t inc to 101, chills, & weak; MN t104 & MD was called who instructed cool bath & APAP; morning pt began to improve & now doing well; Y 12/02/1994 12/02/1994 0 NONE PUB PUB NONE NONE NONE CA94169

70250 01/09/1995 FL 12.06 12 M 12/27/1994 pt was vaxed in nurse's area & 10 mins later was leaving building & almost passed out-was seated on chair-found to be pale, diaphoretic c/o unable to see well; BP 90/60 strong; Y 12/27/1994 12/27/1994 0 NONE PUB PUB PPD by Connaught lot#238011 NONE NONE FL94097

70251 01/09/1995 MO 0.03 0 .3 M 12/23/1994 short episodes of apnea, violent shaking for several minutes, these all occured 7 hrs p/vax; also had severe crying for approx 2 1/2 hrs, during apnea pt went very limp, vomitted forcefully several times; Y 12/05/1994 12/05/1994 0 PUB PUB NONE NONE NONE pt's sibling exp t105, vomitting & shallow breathing @ 4mos & 6 mos w/DTP dose 2 MO95001

70252 01/09/1995 MO 0.05 F 12/28/1994 pt wakened crying nursed briefly from bottle, then became letharigc w/sl jerky movements, eyes open & unfocused; appeared unresponsive x 2 min; lethargy cont'd approx 30-45min until pt fell asleep; afebrile; slept through noc w/problems; Y 12/27/1994 12/28/1994 1 NONE PUB PUB infant APAP NONE NONE pt exp crying @ 2mos w/DTP/OPV/HIB dose #1; MO95002

70253 01/09/1995 MO 30.00.00 30 F 12/28/1994 1 1/2 hrs p/vax pt started to break out in hives; notified clinic was referred to pvt MD; MD gave DPH; Y Y 12/27/1994 12/27/1994 0 NONE PUB PUB NONE NONE NONE NONE MO95003

70254 01/09/1995 MO 0.04 0 .4 M 12/16/1994 22NOV94 t103-104; irritable; cried & screamed; 25NOV94 mom reported pt had episode of gasping & wheezing & took pt to see MD; MD stated TM's were dull w/rt side somewhat reddened; throat clear; heart had regular rate & rhythym; lung clear Y Y 11/22/1994 11/22/1994 0 25NOV94 CXR PUB UNK NONE NONE MO95004

70255 01/09/1995 ND 50.07.00 50 F 12/30/1994 on the same evening of receiving vax pt devel h/a, chills, aching, nausea; h/a cont for next 2-3 dasy; also devel sinusitis & bronchitis tx ATB x 3 wks; c/o chills, diaphoresis, flushing 2-3xday; states has no energy; MD states poss virus; Y 10/20/1994 10/20/1994 0 CRP, WBC has been drawn on a couple occasions w/results being normal PUB PVT Prozac in October, Mexitil, Calan, Premarin, Provera, Synthroid, Seldane, Norpace, relafin, DPH; NONE asthma, arthritis, cardiac dysrhythmias, hypertens, allergy to PCN, HCTZ, sulfa pt exp similar complaints w/flu vax in 1990; ND94022

70256 01/09/1995 NE 0.01 0 .1 F 12/30/1994 Babysitter found pt expired 6AM 28DEC94; Y 12/28/1994 N 12/08/1994 autopsy in progress PUB PUB NONE NONE NONE NE9427

70257 01/09/1995 OH 0.03 0 .3 M 12/21/1994 pt recvd vax & 3PM became irritable, high pitched, crying & kept getting worse, became inconsolable, mom noted stiffness of arms, legs; swallowing problems; pulling @ head & ears; t103 fever axillary; no vomiting; Y Y 07/25/1994 07/25/1994 0 NONE PUB PUB NONE NONE ?milk allergy OH94132

70258 01/09/1995 CA 1.09 1 .9 M 01/03/1995 fever, sz, w/apnea; Y Y 1 Y 12/30/1994 12/30/1994 0 CXR, CBC, ER panel PUB PUB NONE NONE pt exp sz ? @ 10mo w/DTP; CA95020

70259 01/09/1995 NM 40.00.00 39 M 12/29/1994 rashes; similar sx to toxic shock but on arms & hands; Y 5 12/01/1993 unk/blood drawn; PVT PUB Depakote PCN

70260 01/09/1995 CA 0.02 0 .2 M 12/15/1994 pt recvd vax 14DEC94 & had apneic episode turned pale & sl blue color & was unresponsive EMS called taken to ER evaluated 1915 pt was alert, vigorous, crying loudly during attempt to start IV; has done well since transfer to another hosp; Y Y 1 Y 12/14/1994 12/14/1994 0 135/103/9/120;5.2/22/.14; 20.5//166/327/33; N49, L40.7, ANC 10.1; CXR nl; PVT PVT NONE pt does have Melarses adductus in cast on feet bilat NONE

70261 01/09/1995 MI 33.07.00 33 F 12/22/1994 fever, joint aches, neck pain-beginning 13NOV994; sent to clinic 14NOV94; fluids & APAP; Y Y 11/03/1994 11/13/1994 10 PVT PVT Synthroid fever, joint & neck pain PCN, taking Synthroid NONE

70262 01/09/1995 OH 57.04.00 57 F 01/03/1995 post-vaccine synd-myalgias, weakness; Y 4 Y 11/16/1994 11/16/1994 0 UNK UNK NONE

70263 01/09/1995 TX 1.03 1 .3 M 01/02/1995 SOB, lips blue, facial color white; Y 1 Y 01/02/1995 PVT PVT NONE NONE NONE

70264 01/09/1995 CA 26.06.00 26 F 12/21/1994 abdo pain, nausea, fever 104, seen in ER 6DEC94 recvd IV fluids, CBC, cXR, UA dx'd viral synd; Y Y 12/05/1994 12/06/1994 1 CBC, CXR, UA PUB PUB NONE NONE NONE

70265 01/09/1995 CA 20.02 20 M 12/02/1994 pt recvd vax 29NOV94 then reported to sick call 2DEC94 w/ c/o rash, swollen throat/tightness; tx Ataxax; Y Y 11/29/1994 11/30/1994 1 PE/assessment; MIL MIL NONE NONE NONE NA

70266 01/09/1995 MA 1.05 1 .5 F 12/19/1994 high pitch screaming for 3-4 hrs, irritability for 2-3more hrs; low grade fever; Y Y 12/09/1994 12/09/1994 0 PVT UNK NONE URI, nasal congestion NONE NONE

70267 01/09/1995 26.00.00 26 F 11/21/1994 swelling of tongue, circumoral swelling & periorbital swelling, coughing; Y Y 11/18/1994 11/18/1994 0 NA MIL MIL Motrin NONE NONE NA~ ()~~0.00~Patient

70268 01/09/1995 IN 0.07 0 .7 M 12/30/1994 pt devel high fever & short sz; when seen in ER few minutes later acted nl; lab WNL; observation of 24 hrs-no sign neuro deficit; no fever; Y Y 12/08/1994 12/09/1994 1 clinical exam; CBC PVT PVT neonatal sz

70269 01/09/1995 AZ 0.09 0 .9 M 01/05/1995 pt recvd vax 23DEC94 & 6 hrs later devel head jerking, eye blinking & staring; pt became unresponsive was taken to ER & had t102; Y U 12/23/1994 12/23/1994 0 EEG has been ordered-results pending; PVT OTH NONE oral candidisis NONE

70270 01/09/1995 MN 41.09.00 41 F 01/04/1995 t102+ x 2 days missed 1 1/2 days of work; rt arm & glands swelled so much could not get a blouse over it; subsided p/3 days; Y 11/28/1994 11/29/1994 1 PUB PUB NONE NONE sulfites-sulfur dioxide

70271 01/09/1995 NY 1.03 1 .3 F 01/05/1995 c/o swelling of face, coughing, fever 102; Y 10/11/1994 10/11/1994 0 PVT PVT NA NA

70274 01/09/1995 NC 1.03 1 .3 U 12/30/1994 inc measles-like rash 2 wks later 102-103 fever (4th pt from same batch w/full-fledges fever, rash, URI sx etc); Y 12/15/1994 12/23/1994 8 PVT PUB well baby

70275 01/09/1995 WA 46.07.00 46 F 01/05/1995 7inch x 4inch area of edema & erythema lt deltoid region; U 12/30/1994 12/31/1994 1 PVT UNK NONE Sulfa NONE

70276 01/09/1995 NJ 0.02 0 .2 M 12/30/1994 pt had inconsolable crying for 6hr & questionable high pitched cry ? as reported by parent, but not heard by MD over phone; tx APAP; will not give further pertussis vax; Y 12/15/1994 12/15/1994 0 PVT PVT NONE NONE NONE NONE

70277 01/09/1995 CA 74.00.00 73 F 12/22/1994 severe edema over lt deltoid muscle (site of inject), erythema & pain down to elbow; Y 12/19/1994 12/20/1994 1 NONE PVT PVT Cilamin SQ, Fergon, Vit B12 IM, Synthroid; NONE chronic anemia w/splenomegaly/pernicious anemia, hypertension, graves disease, iron deficit, pagets dis of bone, hepatitis

72343 01/09/1995 OH 77.07.00 77 F 09/27/1994 pt recvd vax; 2 hrs later, devel v & d, lasted about 1 hr & resolved; Y 09/06/1994 09/06/1994 0 PUB OTH premarin none none 894279002K

70278 01/10/1995 MA 0.04 0 .4 M 01/05/1995 pt recvd vax;was dazed for 5 days following vax;pt devel a T 3.2;cholesterol,serum 245 H;iron binding capacity 397H Y 11/30/1994 12/02/1994 2 renin,plasma=4.10 H;high renin hypertension >3.2;cholesterol,serum=245 H;IBC/RFX (iron binding capacity) =397 H;MIL PVT chlorthol; resopril; aspirin none none

70301 01/10/1995 AZ 0.04 0 .4 F 01/03/1995 pt recvd vax; seversl hrs later devel fever of 102; high pitched cry x 4 hrs; appeared well afterwards; Y 11/08/1994 11/08/1994 0 none PVT PVT none none none none

70302 01/10/1995 AZ 0.02 0 .2 M 01/03/1995 pt recvd vax; 9 hrs later, pt became very lethargic,pale,blue,weakly arrousable, rectal t 97.0; remained very lethargic, sleepy x 4 hrs then returned to nl status; pt now well on exam; Y 11/22/1994 11/22/1994 0 none PVT PVT baby-lax none none none

70303 01/10/1995 CA 1.02 1 .2 M 12/23/1994 pt recvd vax;15 mins later, rt leg swelling/redness;size of quarter;DPH, advil given; ice pack to rt leg; Y 12/23/1994 12/23/1994 0 none OTH OTH

70304 01/10/1995 FL 73.06.00 73 M pt recvd vax;onset eve 16nov94;devel fever 102; chilly sensations;less fever on 17nov & 18nov (not recorded) Y 11/16/1994 11/16/1994 0 chest x-ray=clear of active disease PVT PVT insulin;coumadin,isorbide DN;metropol;procardia XL;prozec;ASA none diabetes mellitus;atrial fibrillation;hypertension (controlled);cor heart disease;OLD CABG 1978;gen arteriosclerosis w/ mild dementia

70305 01/10/1995 MA 0.02 0 .2 M 01/05/1995 pt recvd vax; apap given immediately p/ vax;approx 7:08pm 21oct94 started crying, high pitched & unconsolable x 3 hrs; Y 10/21/1994 10/21/1994 0 none PVT PUB none none none

70306 01/10/1995 CA 41.08.00 41 F 12/12/1994 pt recvd vax;exp tightness in chest, cough non productive w/in 2 hrs of vax; leg achiness,flushed; ?fever Y 11/03/1994 11/03/1994 0 UNK UNK codeine

70307 01/10/1995 CA 1.03 1 .3 F 01/05/1995 pt recvd vax; sz & fever to 102 several hrs p/vax;pt nl at f/u exam w/in 45 mins; Y 11/18/1994 11/18/1994 0 PVT PVT none none

70308 01/10/1995 WY 0.04 F 01/03/1995 pt recvd vax; devel fever 102.8 despite antipyretics; severe myalgias; crying >3hrs; Y 11/08/1994 11/08/1994 0 na PVT PUB none none in brother, t >103 at 4 mo w/ 2 dtp;

70309 01/10/1995 VA 47.03.00 47 F 01/05/1995 pt recvd vax;had 10 days of diffuse distal proximal lt arm pain;motor sensory,pulse;joint exams were nl;no crepitus;provisional dx was tendonitis;cont to adm naprosyn (alleve),added warm soaks;sxs gradually resolved over 2 1/2-3 wks; Y 11/28/1994 12/08/1994 10 none PVT PVT none none none

70310 01/10/1995 AR 37.02.00 37 F 01/04/1995 pt recvd vax;arm hurting immediately p/vax;arm sore throughout wk end,could not use arm;pain cont for wks afterwards Y 10/28/1994 10/28/1994 0 PVT PVT

70311 01/10/1995 AR 34.03.00 34 M 01/04/1995 pt recvd vax;arm began to hurt immediately;could not move arm although pain was not so severe;cont to hurt x wks Y 10/28/1994 10/28/1994 0 PVT PVT

70312 01/10/1995 TX 0.02 0 .2 F 01/04/1995 pt recvd vax;3-4 hrs later,pt had a 5min spell of being very pale & somewhat limp & irritable;no fever,no further sxs beyond 24 hrs; Y 11/21/1994 11/21/1994 0 none PVT PVT none none

70313 01/10/1995 U pt recvd vax; nauseous for a while; UNK UNK had diphtheria as a child

70532 01/10/1995 NY 0.02 0 .2 F 01/06/1995 high pitched screams, LOC, brain swelling, convuls, anemia; excessive sleepiness; intercrainial bleed; resp distress; Y Y Y 21 U 11/08/1994 11/11/1994 3 MRI, CT Scans, Vision tests, EEG, Brainstem, Blood work, CXR's PVT OTH NA NA colic (mom has severe reactions to meds/foods)

70522 01/11/1995 65.00.00 F 01/10/1995 pt vaxed 17OCT94 & 5NOV94 exp epigastralgia; 2 days later exp weakness in legs which gradually inc during the wk; hospitalized on 11NOV94 w/generalized neuropathia in arms/legs bilat peripheral facialis paresis; 21DEC94 pt improving; Y U 10/17/1994 11/05/1994 19 OTH OTH NONE NONE NONE EML95003

70524 01/11/1995 AL 1.03 1 .3 M 11/30/1994 immed p/vax skin @ lt thigh became blotchy red; pt not restrained well to use arm for MMR-immediate 5 cm wheal devel w/tenderness & redness; called clinic MD gave DPH subsiding swelling p/10 mins; will not eat; viral infect; Y Y 11/30/1994 11/30/1994 0 NONE PUB PUB NONE URI afebrile 97.4 ax; NONE AL9446

70525 01/11/1995 AL 1.05 1 .5 M 12/05/1994 devel 5cm wheal, redness & blotchy skin sorrounding inject site immed p/receiving MMR; No problems w/DTP/HIB; Y Y 12/05/1994 12/05/1994 0 PUB PUB NONE URI NONE AL9447

70526 01/11/1995 AL 4.03 4 F 11/30/1994 red blotchy skin over DTP inject site then p/receiving MMR developed raised wheal 5cm red 10 cm area; DPH given 930AM p/examined pt BP 80/60 P90 R28 clear lungs; arm still has swelling; Y Y 11/30/1994 11/30/1994 0 NONE PUB PUB NONE URI 97.4 ax temp allergic to mold food berries AL9448

70527 01/11/1995 CT 1.03 1 .3 F 01/10/1995 pt recvd vax 30DEC94 & 9JAN95 t120-103 & convuls; 10JAN94 still febrile (t103.4); pt requiried no medical visit; Y 12/30/1994 01/09/1995 10 NONE PVT PVT NONE NONE NONE NONE CT9501

70528 01/11/1995 NC 71.03.00 71 F 12/14/1994 pt recvd vax 10OCT94 & arm felt warm p/1st day & was hurting; 28OCT94 sore arm could not get arm above head due to soreness; 15NOV94 seen by MD due to arm pain; 9DEC94 nerves are twitching & sore to touch, knot; diff breathing; Y N 10/10/1994 10/10/1994 0 PUB PUB THyroid, inhalers: Atrovent, Ventolin, Beclovent TID Emphysema, chronic bronchitis cholecystectomy-1950's; no allergies, birth defects; Emyphsema, chronic bronchitis NONE NC94140

70529 01/11/1995 NC 41.05.00 41 F 12/07/1994 sx progressed from local react to systemic-local swelling, redness, tenderness, feverish, fatigue, aching, flu-like sx; seen by MD 5DEC94 prescribed Keflex 220mg; 1 qid x 5 days; Depro 600 1-2 bid for swelling; Y Y 11/28/1994 11/29/1994 1 NONE PUB PUB PPD by Connaught lot# 234811; estrogen, Eye gtts Glaucoma NONE Glaucoma NC94141

70530 01/11/1995 SD 0.02 0 .2 F 12/23/1994 unconsolable crying for 8 hrs (3-11PM); Y 12/14/1994 12/14/1994 0 NONE PVT PUB NONE SD95001

70531 01/11/1995 NM 0.02 0 .2 M 12/19/1994 pt recvd vax 16DEC94 in the afternoon; mom says pt cried & screamed nearly continually thereafter sleeping for less than an hr @ a time until went to sleep 0200AM 18DEC & was found @ 0400 dead in bed; slept 2 hrs p/vax then started crying; Y 12/18/1994 N 12/16/1994 12/16/1994 0 PVT PUB NONE NONE NONE

70533 01/11/1995 HI 31.05.00 31 F 13DEC 2 wks p/vax pt devel fever up to 103 w/ n,v, cough, non prod, +rash chest-maculopap, faintly erythematous, also on back & neck; then devel dec WBC=2.2 15DEC94 & also transient encephalitis 16DEC94; Y Y 12/01/1994 12/11/1994 10 14DEC94 urine culture-E.Coli; 16DEC94: CMV,, IgG,AB 2.62H; SGOT 814; SGPT 107H; Alk phos 683H; Reactive lymph 24H; lymphocyte 51H; Neutrophil 14L; GammaGT 358HPUB UNK

70534 01/11/1995 MD 0.02 0 .2 F 01/06/1995 febrile seizure (102.6) lasting approx 3 mins; evaluated by paramedics; seen in office for eval p/sz; Y Y 01/05/1995 01/05/1995 0 NONE PVT PUB NONE NONE NONE NONE

70535 01/11/1995 PA 1.06 1 .6 M 01/06/1995 had vax 5JAN95; in Am 6JAN95 had convuls (lasted 3 mins generalized); ? if associated w/fever dx w/strep pharyngitis 8JAN95; Y Y 01/05/1995 01/06/1995 1 H/H 11.7/35.1; PH 251.000; wBc 17,600 w/67% polys, 15% Bands, 16% lymphs, 2% monos; NA 137, K 5.2, Cl 101, Co2 23, Glucose 119, BUN 9, CR 0.4; Mg 2.3; Ca 10.1PVT PVT mild URI NONE NONE

70536 01/11/1995 WA 40.01.00 40 F 01/05/1995 pt recvd vax & noticed immed numbness in arm & saw MD next day w/ c/o dec strengthin arm, red welt @ site & on neck, blotchy skin on shoulder; conversation w/MD on exam MD felt this was an extreme local react, not an allerg react; Y Y 10/25/1994 10/25/1994 0 NONE PUB OTH Injectable Luprin NONE allergic to PCN & Anaprox NA

70541 01/12/1995 NY 1.00 1 .0 F fever 104.5, diarrhea, cough 12/13/1994 12/13/1994 0 OTH PUB NONE NONE NONE BA94M34

70542 01/12/1995 NY 40.02.00 40 F 01/05/1995 h/a, arthritis from knees/neck now still on hand; arthritis devel approx 2 wks after; 12/13/1994 12/30/1994 17 OTH OTH BA095Q001

70543 01/12/1995 IL 1.04 1 .4 F 12/27/1994 mom reports pt began shaking around 1130AM & cont until called well child staff & was instructed to go to hosp immed; mom gave APAP; pt felt hot-fainted; pt had febrile sz; also had BOM; Y Y 12/16/1994 12/16/1994 0 PE revealed bilat OM by MD; PUB PUB PPD (Mantoux) by Connaught lot# 237611; not known to be ill @ time of vax; heart murmur (nl EKG & Echo); NA IL940151

70544 01/12/1995 IL 53.01.00 53 F 12/23/1994 pt called on 12DEC94 states arm was sore evening p/flu vax given in lt deltoid; progessively got worse for several weeks; currently arms is swollen, warm to touch, w/restricted mobility due to pain; referred to PMD for treatment; U 10/19/1994 10/19/1994 0 14DEC94 tC pt seen by MD blood tests showed no infect; taking anti-inflamatory med is better; PUB PUB NK NK IL940152

70545 01/12/1995 NC 0.05 0 .5 F 12/16/1994 pt w/URI sx, s/p vax 13DEC94; mom gave APAP x 48 hrs; unsure when pt became febrile; found blue & apneic in bed 16DEC94 early AM; EMT's found in full cardioresp arrest & intubated & initiated CPR; temp on arrival in ER 104.1 p/45 mins dead; Y 12/16/1994 N 12/13/1994 12/16/1994 3 BCX pos meth resistant staph (coag pos); PUB PUB URI per mom NKA 2 prev febrile illness w/high fevers NC95001

70546 01/12/1995 NC 19.05 19 F 12/29/1994 red, warm, itchy area around inject site about size of nickle; scattered red, discrete macules upper lt arm & both legs (itches) pt is also taking sulfa x 7-10 days; Y Y 12/27/1994 12/27/1994 0 NONE PUB PUB SUlfa recovering from sinus infect & otitis NONE NONE NC95002

70547 01/12/1995 VA 12.08 12 M 12/28/1994 hives, wheezing, emesis, sneezing, coughing, airway swelling, facial edema p/vax w/in 10 mins of vax; anaphylaxis; Y 12/28/1994 12/28/1994 0 NONE UNK UNK Epi, DPH hx severe histanine response to different allergins tomatoes, boloney, hot dogs, etc;

70582 01/13/1995 PA F 12/28/1994 pt recvd vax;on 2oct94 adm to hosp w/ a spinal epidural hematoma;pt recovered w/out residua;neurosurgeon states the cause of hematoma is unk;however,does not feel it is related to flu vax;pt will be followed w/ MRI exams; Y Y 09/21/1994 10/02/1994 11 Percutaneous needle biopsy & MRI showed only epidural blood clot; PVT PVT none hx of breast cancer; rxn unevaluable; 895003003Z

70583 01/13/1995 AL 65.00.00 64 F 12/27/1994 pt recvd vax;pt reports 4 days p/vax,started having numbness in toes both feet but lt side is worse;seen by different MD;on prednisone & imoran; myasthenia now ruled out;final dx: GBS, ?peripheral neritis; Y Y N 10/08/1992 10/12/1992 4 GBS, ? peripheral neritis final dx; myasthenia; PUB PUB none per pt; none per pt on 27dec94 denies any on 27dec94 AL9449

70584 01/13/1995 LA 4.07 4 F 10/07/1994 pt recvd vax; upper arm swelled & a rash formed on upper arm & chest area; Y 10/06/1994 10/06/1994 0 PUB PUB LA950101

70585 01/13/1995 MO 0.04 0 .4 F 01/03/1995 pt recvd vax; t 103.6;dec to 101.4 w/ apap;extreme irritability; refusal to eat for 24 hrs; par did report this to ped; no tx deemed necessary Y 12/28/1994 12/28/1994 0 none PUB PUB none none none MO95005

70586 01/13/1995 NJ 0.03 0 .3 M 01/05/1995 pt recvd vax;began screaming x several hrs p/vax,cont intermittently for 12-15 hrs;would be quiet x 10-15 mins;awaken screaming; fever 102 x 12 hrs; apap given x 24 hrs; pmd advised dt for next immun; Y 11/30/1994 11/30/1994 0 none PUB PUB none none none na NJ9475

70587 01/13/1995 WV 0.03 0 .3 M 12/13/1994 pt recvd vax; crying for more than 3 hrs; inc WBC; pain; adm to hosp for observation; Y 1 Y 12/09/1994 12/09/1994 0 PVT PUB nasopharyngitis vatus synd WV9501

70588 01/13/1995 IL 1.05 1 .5 F 01/05/1995 pt recvd vax; simple febrile sz;t of 104; Y Y 1 Y 12/21/1994 12/31/1994 10 lytes, calcium,magnesium,lead level, all nl; PUB PUB none occasional otitis med IL950003

70589 01/13/1995 CA 1.04 1 .4 F 05/07/1994 pt recvd vax; exp fever, lasting x 4 days p/ vax; t 103 R when seen in ofc; Y U 05/03/1994 05/04/1994 1 dx:strep tonsillitis 9may94; PVT PVT none none none

70590 01/13/1995 FL 0.03 0 .3 F pt recvd vax; mom states pt started screaming p/ shots & had unusual high pitched screaming x prolonged periods of time for 48 hrs; Y Y 12/19/1994 none PVT PVT URI

70591 01/13/1995 MO 41.02.00 41 F 12/16/1994 pt recvd vax;2 days later,noticed rash (raised red welts) on side of both arms,from armpits to wrists like goosebumps; not itchy; gradually faded, but noticeable for 1 wk; Y 12/06/1994 12/08/1994 2 PUB PUB sodium cromolyn 1985 : rast-egg-white food allergy moderate in mom,will not take flu shot because previous shots would weeps out;

70592 01/13/1995 VA 67.07.00 67 M 01/10/1995 pt recvd vax; arm red, swollen & hot; next day pt had flu sxs; Y 12/08/1994 12/09/1994 1 PVT PVT none none

70593 01/13/1995 TX 1.03 1 .3 F 01/09/1995 pt recvd vax; devel rash at inject site; spread to legs & arms; Y 01/04/1995 01/06/1995 2 PVT PVT none none none none

72344 01/13/1995 NY M 11/30/1994 pt recvd vax; devel lump at site, 7 1/2", hives for 24 hrs; tx w/ dph; Y 10/19/1993 10/20/1993 1 UNK UNK CO5050

80531 01/14/1995 CA U pt recvd vax 22SEP94 & 23SEP94 pt presented in sick call w/either a fever &/or local or systemic rxn;sxs resolved p/several days; Y Y 09/22/1994 09/23/1994 1 No relevant data; MIL OTH Bicillin WAES94091067

80562 01/14/1995 PA 51.04.00 51 F pt recvd pneumovax & flu vax on 3OCT94 & inadvertently recvd 2nd dose of pneumococcal vax 17OCT94 & 18OCT94 pt devel a sore arm & recovered; Y 10/17/1994 10/17/1994 0 No relevant data; PVT PVT WAES94100552

70596 01/17/1995 NY 3.04 3 M 01/09/1995 pt recvd vax; difficulty breathing, face turned purple Y U 01/06/1994 01/06/1994 0 PVT UNK asthma BA95K003

70597 01/17/1995 LA 36.03.00 36 M 01/03/1995 pt recvd vax;BP nl 130/80;shaking,nervous;graish color, confused;hands swollen;epi given;ativan prescription;events started w/in 5 mins of vax; Y Y 12/27/1994 12/27/1994 0 OTH PVT none none none uncle had sz w/ immun LA950102

70598 01/17/1995 ME 20.07 20 F 01/11/1995 pt recvd vax;approx 14 hrs later,devel hive like rash covering arms,legs,trunk & buttoks assoc w/ intense itching;3jan95 sought med hlth,evaluated by MD;c/o no fever or respiratory problems;fully recovered;tx w/ suldane POBID; recovered Y 12/30/1994 12/31/1994 1 none PUB PUB none none none ME95001

70599 01/17/1995 MS 0.06 0 .6 F 12/23/1994 pt recvd vax;began crying;would not stop; would not move arms,legs;called MD; advised dph in addition to apap; not examined by MD; Y 12/13/1994 12/13/1994 0 none PUB PUB none none none MS94069

70600 01/17/1995 MS 56.05.00 56 F 12/28/1994 pt recvd vax;sl swelling around site of reddened area approx 4"x3" size; itching badly; U 12/20/1994 12/25/1994 5 PUB UNK none none none MS94070

70601 01/17/1995 NC 1.04 1 .4 M 01/03/1995 pt recvd vax;15dec94 checked by MD for rash;T 103 ax,malaise;20dec94 rechecked by MD, dx w/ AOM & t 104ax;pt dx w/ Rubella rash,was instructed to file VAERS; 3jan95 mom reports pt "OK" now; Y 12/02/1994 12/15/1994 13 none PUB PUB none none none none NC95003

70602 01/17/1995 NC 1.02 1 .2 M 01/03/1995 pt recvd vax; 30dec94 checked by MD for rash & t 102 ax x 3 days;instructed to file VAERS per MD; 3jan95 mom reports pt "OK" now; Y 12/12/1994 12/27/1994 15 none PUB PUB none none none none NC95004

70603 01/17/1995 NH 0.00 0 .0 F 12/29/1994 pt recvd vax;COD SIDS; Y 07/13/1994 N 06/24/1994 07/13/1994 19 PUB OTH ampicillin; phytonactione,lotycin ophthalmic; none gastroesophogeal reflux NH94027

70604 01/17/1995 SC 0.02 0 .2 M 10/19/1994 pt recvd vax at 1pm;approx 3:45pm started v,turned pale,listless,high pitched cry;to MD,BP high 110/90;hypotonia & lethargy;noted to be fretful; Y 2 Y 10/05/1994 10/05/1994 0 PUB UNK none none none SC9498

70605 01/17/1995 SC 27.09.00 27 F pt recvd vax; noticed small area of swelling 19aug94 lt arm area;inc to 8cm;area reddened,tender,warm to touch;no broken areas of skin noted today although pt states did have a few "bumps" on area but did not drain any fluid; Y U 08/09/1994 08/19/1994 10 PUB PUB 777 ortho novum none none SC94107

70606 01/17/1995 SC 0.05 0 .5 F 12/02/1994 pt recvd vax;mom states began high pitched cry lasting x approx 3 hrs;t 103;both starting 4-6 hrs p/ vax;called PMD who said,no more pertussis vax;both sxs resolved w/in 24 hrs;mom reported this to hlth dept on next visit for immun; Y 02/04/1994 02/04/1994 0 none PUB PUB apap none per mom allergy to keflex SC94114

70607 01/17/1995 SC 10.06 10 F 11/18/1994 pt recvd vax;@ 8:45 fainted;color pale;pupils dilated;hands & arms shaking;less than 1 min;aroused w/ amonia capsule;v;BP 80/52 at 9:10pm; P=82;color fine;discharged at 9:30pm w/ mom; Y 11/18/1994 11/18/1994 0 PUB UNK none none mom states pt has asthma; SC94115

70608 01/17/1995 SC 0.04 0 .4 F 11/22/1994 pt recvd vax; 2 1/2 hrs p/ vax,began screaming intermittently at 15-20 mins intervals,over a 3 hr period; no oth sxs; fine after that; Y 09/13/1994 09/13/1994 0 none PUB PUB SC94116

70609 01/17/1995 SC 34.09.00 34 M 12/08/1994 pt recvd vax;pt c/o pain in lt arm;weakness in lt hand p/ vax;23nov94 instructed to see MD;8dec94 sxs worse;unable to contact; Y U 10/31/1994 10/31/1994 0 PUB UNK none codeine SC95001

70610 01/17/1995 SD 47.02.00 47 F 01/04/1995 pt recvd vax;started getting cough & shortness of breath;sxs got worse;chest pains & bad ha;felt like had case of terrible flu or a bad heart condition;still felt ill next day; Y 11/17/1994 11/17/1994 0 OTH PUB na na only high cholesterol test na SD95002

70611 01/17/1995 SD 1.03 1 .3 F 01/10/1995 pt recvd vax;mom called office stating pt had sz at noc;described it as a "trembling" of whole body,lasted approx 1-1 1/2 mins;mom states 2 prior sz assox w/ fever but never p/ a vax;apap given 9jan95;had sz on 10jan95 at 3:30am; Y Y 01/09/1995 01/10/1995 1 PUB PUB na cold, no fever 2 prior sz assoc w/ fever; SD95003

70612 01/17/1995 WV 1.02 1 .2 F 01/11/1995 pt recvd vax; apparent sz like activity 3 days post immun; Y U 01/03/1995 01/06/1995 3 scheduled for EEG; PUB PUB monovax by connaught, lot #j01783 URI-non febrile PNC na WV9502

70613 01/17/1995 IL 4.08 4 M 01/12/1995 pt recvd vax;5-10mins later,collapsed & was unconscious;1 1/2 hrs later had generalized sz; unresponsiveness;in er;pale,dec tone;dec response;referred to ped neurologist; Y Y 2 U 01/10/1995 01/10/1995 0 CT scan neg PUB PUB none none none unk IL950005

70615 01/17/1995 MI 1.05 1 .5 M 01/10/1995 pt recvd vax & 2 hrs later had 3-5 min convuls sz including turned blue & stopped breathing for 30 sec; EMS arrived pt was recovering but took to ER to check out; blood & urine work nl; followed up w/pediatrician next day-all was fine; Y Y 4 Y 12/01/1994 12/01/1994 0 MRI, EEG, CT Scan, Spinal tap & blood & urine all neg; PVT OTH Tri Vi Flor vitamins; sinusitus & UPI NONE NONE

70616 01/17/1995 MI 1.05 1 .5 M 01/09/1995 fever, irritability, convuls Y Y 1 Y 01/03/1995 NA PVT PVT NONE amoxicillin-rash

70617 01/17/1995 PA 1.03 1 .3 M hosp adm due to sz & high fever 8DEC94; had MMR 8 days prior; CBC-nl x/sl inc MCV 76.9- diff 15% monos otherwise unremarkable;CO2 = 19.3 - subsequent CP nl; spinal fluid neg; gram stain-bacterial antigens; Y 3 Y 11/29/1994 12/08/1994 9 CXR nl; urine neg; bl cult no growth; glucose 75; protein 11; f/u EEG 27DEC94 nl; PVT PVT pt recvd HIB by Prais lot# M130KE 29NOV94 NONE h/o neonatal apnea-was on monitor approx 4 mos was under care of MD; pt was 5 wk premie;

70618 01/17/1995 CA 0.02 0 .2 M 01/09/1995 2-3 hrs p/inject, t102, inconsolable crying & dec feeding, marked swelling of rt thigh; pt screams until collapsed w/exhaustion then sleeps; Y 1 Y 11/23/1994 11/23/1994 0 CBC (low RBC, HGB, HCT) WBC-ok=7.2; UA no infect OTH OTH Vidaylin; APAP drops NONE NONE

70619 01/17/1995 NJ 42.08.00 42 M 01/10/1995 pt recvd vax;adm to hosp w/ GBS a 1 wk & a half to 2 wks p/ vax; Y Y Y N 11/16/1994 11/27/1994 11 PVT PVT keflex laceration lt ear;possible viral illness pcn;

70620 01/17/1995 FL 0.02 0 .2 F 01/10/1995 eyes rolled back in head x7,T100.5 even before;to MD; pt holding head to rt side & stiff; eyes rolled back in head while being weighed; adm to hosp; Y 6 Y 12/21/1994 12/22/1994 1 PVT PVT none stated none none CO5805

70621 01/17/1995 MD 0.05 0 .5 M 01/12/1995 myoclonic sz 24 hrs p/vax adm to hosp nl EEG w/resolution of sx; Y 3 Y 01/05/1995 01/06/1995 1 EEG- 48 hrs monitored/MRI PVT PVT Augmentin persistent rt OM

70622 01/17/1995 AZ 0.02 0 .2 F 01/11/1995 apnea x 1-now on apnea monitor-doing well; Y 1 Y 12/29/1994 12/29/1994 0 PUB OTH APAP NONE premature-3 1/2 wks early

70623 01/17/1995 TX 1.03 1 .3 M 01/11/1995 pt recvd vax;PC from mom 5jan95,states pt had high fever due to possible immun;motrin given q 4 hrs x 48 hrs;next day took pt to clinic w/ generalized rash all over body;dph prescribed;by next day,fever & rash had subsided;on 11jan pt fine Y Y 01/04/1995 01/05/1995 1 unk PUB PUB motrin, dph; none none none TX95005

70624 01/17/1995 CA 3.07 3 M 01/10/1995 pt recvd vax & c/o severe burning in leg 1/2 hr p/ vax;entire upper thigh,and genital area red & inflamed;tx w/ cold compress & dph;next day inflammed area severely bruised;remained that way for > 2 wks;very tender to touch;skin peeling Y U 01/04/1995 01/04/1995 0 nl TB test result; PUB PUB TB test given 4jan95; none none CA95018

70625 01/17/1995 NY 68.01.00 68 F 01/09/1995 pt recvd vax;hissing/ringing in ears constantly;to MD;ear spec;had MRI, blood work all neg;MD put pt on anti-depressants for insomnia; Y N 10/07/1994 11/01/1994 25 neg hearing test PVT UNK none none none

70626 01/17/1995 PA 1.02 1 .2 F 01/11/1995 pt recvd vax;to er w/ febrile sz; eyes rolled to back of head;shaking of all limbs; concurrent BOM found;pt recvd IV & was prescribed vantin x 10 days; Y Y 01/09/1995 01/10/1995 1 PVT PVT URI-afebrile

70627 01/17/1995 HI 1.02 1 .2 M 01/10/1995 fever 103 in spite of APAP w/lt leg mild swelling & non use; vax given 1010 fever late PM/evening & into noc; t103 still @ 0500 AM; down to 99 w/APAP @ 1400 10JAN95; Y Y 01/09/1995 01/09/1995 0 NONE MIL MIL APAP NONE NONE

70628 01/17/1995 MT 0.02 0 .2 M 01/11/1995 4 1/4 hrs p/vax pt was limp, very pale & brought to ER where extreme pallor & dec RR noted; resolved over 2 hrs; Y Y 01/10/1995 01/10/1995 0 CXR, CBC done-WBC inc 26,000; PVT PVT NONE NONE NONE NONE

70629 01/17/1995 NJ 13.06 13 F 01/11/1995 initially pain, redness, swelling-sl dec followed by inc swelling, pain ( wks post) seen 28NOV rx Keflex-inc swelling, pain-referred to dermatologist-rx Cipro x 1 wk; 25DEC pain, red lump @ site tx 2JAN95 I&D abscess, Cipro x 1 wk; Y N 10/24/1994 10/24/1994 0 PVT UNK NONE NONE in pt, exp abscess w/DT at 1 yr & 2 yr

70630 01/17/1995 CA 0.06 0 .6 M 01/09/1995 fever of 103.2; crying, difficult to console; Y Y 11/22/1994 11/23/1994 1 NONE OTH OTH NONE NONE

70631 01/17/1995 VA 70.03.00 70 F 01/10/1995 redish-pink area from elbow to shoulder hot & itchy; Y Y 12/08/1994 12/10/1994 2 PVT PVT pt recvd TTox by Berna lot# 1212405 25OCT94 NONE

70632 01/17/1995 OH 33.00.00 32 F 01/11/1995 devel difficulty breathing, heart fluttering squad called transported to ER; EPi administered prior to transport; given DPH by ER; sx devel 1 1/2 hrs p/vax still present next day inc HR; also dx w/pneumonia next day; Y Y 11/15/1994 11/15/1994 0 OTH UNK pt recvd HEP B vax by SKB lot# 1411A4 19OCT94; NONE NONE NONE

70633 01/17/1995 GA 0.04 0 .4 M 01/10/1995 ok for 1st 24 hrs then devel intense crying for 1 1/2 -2 hrs @ a time; parents state would fall asleep then wake up & repeat process until seen in office Saturday AM; afebrile; no local react; Y Y 01/05/1995 01/06/1995 1 NONE PVT PUB NONE NONE NONE NONE

70634 01/17/1995 CA 1.03 1 .3 F 01/05/1995 inconsolable crying for 1 hr-4 hrs p/vax given; given APAP 15 mins p/onset of crying; abrupt stop 45mins followed by several quiet mins of staring; no sz activity then returned to nl; Y Y 01/04/1995 01/04/1995 0 NONE PVT PVT NONE NONE NONE

70635 01/17/1995 MN 33.01.00 33 F 12/19/1994 pt recvd vax;15dec,very fine red rash,splotchy on inside of arms/legs;slightly itchy;sclera gray;hands/knees/elbows full of liquids; swollen achy joints;had to use table to sit down & get up from table; joints very painful; U 12/12/1994 12/15/1994 3 PUB PUB none none none MN94049

70636 01/17/1995 PA 0.03 0 .3 F 01/10/1995 mom reported that pt had fever 102.5 dec by APAP on day of vax; no other sx; doing well 24 hrs p/vax; Y 12/20/1994 12/20/1994 0 NONE PUB PUB pt recvd hepB SKB lot# 1538B2 22NOV94; NONE tracheobronchonialacia PA9501

70637 01/17/1995 NY 68.03.00 68 M 01/09/1995 pressure in head-hissing, ringing, sharp rings rt through the head; N 10/07/1994 11/01/1994 25 2 trips to ER; family MD-ear specialist-Neurologist; CAT Scan-blllod test-hearing test; PVT UNK NONE high blood pressure NONE

70638 01/17/1995 WI 34.03.00 34 F 01/09/1995 pt had swelling, reddness, itchy, feverish site, around lt deltoid inject site; covering softball size area; Y 12/27/1994 12/27/1994 0 NONE PVT PVT Tetracycline; ventolin inhaler Lesion removal due tetanus asthma

70639 01/17/1995 PA 0.02 0 .2 M 01/13/1995 pt started shaking & having sz type activity lasting a couple mins in duration; pt was not taken to ER; sx subsided; Y 11/02/1994 11/02/1994 0 NA MIL MIL NONE heart murmur

70640 01/17/1995 FL F 01/06/1995 3-4 hrs p/vax pt started screaming & would not let anyone touch her for 4-6 hrs; pt exp swelling & redness afterwards x 2 days; Y 01/03/1995 01/03/1995 0 NONE PVT PVT NONE NONE NONE NONE

70641 01/17/1995 CO F 01/11/1995 2-3 hrs p/vax given pt arm became swollen & sore x 2 days; Y 01/04/1995 01/04/1995 0 NONE PVT PVT NONE NONE NONE

70642 01/17/1995 CO 0.05 0 .5 F 01/13/1995 pt screamed from midafternoon of day of vax through the noc & most of next day; APAP would give temp relief (about 1-2 hrs); Y 01/11/1995 01/11/1995 0 NONE PVT PVT NONE NONE screams when given DPH; rashes w/yogurt, peas, squash;

70643 01/17/1995 CA 0.04 0 .4 F 01/11/1995 golf ball size; lump @ inject site lt anterior thigh appears non-tender; Y 01/06/1995 01/08/1995 2 PVT PVT NONE

70644 01/17/1995 MS 47.08.00 47 F 01/10/1995 lt hand felt asleep beginning about 10-12 hrs p/vax & lasting 12-14 hrs gradually dec-using lt hand & arm felt awkward; Y 11/03/1994 11/13/1994 10 NONE PVT PVT NONE NONE NONE

70645 01/17/1995 CA U pruritus spreading erythema of inject site finally involves 10 x 5 cm area lt upper arm; rx w/ Hismanal; Y 12/27/1994 01/02/1995 6 CBC was nl; PVT PVT Synthroid NONE NONE

70646 01/17/1995 CO 10.00 F 01/07/1995 105 fever, high pitch screaming (couldn't even hear it-but could see was screaming), convuls then went to sleep; This was the 1st DTP pt recvd pt now 10 yrs old-mom just found out about this form; Y PVT UNK NONE NONE

70647 01/17/1995 IN 0.02 0 .2 M 12/23/1994 cried over 3 hrs persistantly p/last immun 11OCT94 had swelling & redness @ the site of inject; 10/11/1994 10/11/1994 0 PVT PVT NONE

70648 01/17/1995 CA 0.04 0 .4 F 01/09/1995 high pitched scream x 4 hrs p/vax; Y 11/08/1994 11/08/1994 0 NONE PVT PVT NONE NONE NONE pt exp crying x hrs w/DTP #1

70649 01/17/1995 WV 0.02 0 .2 F 01/12/1995 unconsolable crying for 4 hrs w/in the 1st 24 hrs p/vax; Y 01/10/1995 01/11/1995 1 PVT UNK rash on neck NONE

70650 01/17/1995 NE 1.03 1 .3 M 01/10/1995 pt recvd vax 10AM 9JAN95 t102 started @ approx 130PM; temp went to 105 during noc; APAP q 3-4 hrs, tepid baths q 20 mins; 01/09/1995 01/09/1995 0 PVT PVT NONE NONE Augmentin NA

70651 01/17/1995 MD 1.06 1 .6 F t104 w/in 24 hrs of vax; Y 01/10/1995 01/10/1995 0 NONE PVT PVT NONE NONE NONE

70652 01/17/1995 OH 1.03 1 .3 M 01/11/1995 limping; arthralgic lt hip; Y 12/30/1994 01/08/1995 9 CBC; CXR PVT PVT Amoxie chronic serous otitis chronic serous otitis NONE

70653 01/17/1995 NY 6.04 6 M 01/10/1995 following vax 4 cm diameter hive occurred @ needle entrance site w/in 5 mins; no dyspnea; no remote hives; DPH given; pt observed 15 mins then discharged; No further problems occurred; Y 01/10/1995 01/10/1995 0 NONE PVT PUB otitis none, x/OM history

70654 01/17/1995 KY 14.02 14 M 12/29/1994 18 hrs post inject egg sized, warm tender,mass inject site in rt deltoid; no fever; tender in rt axilla; pneumovax given in lt arm w/o discomfort; U 12/27/1994 12/29/1994 2 probably recovering from pneumonia; PVT PVT Ceftin resolving pneumonia asthma

70655 01/17/1995 NY 34.03.00 34 F 12/29/1994 12DEC94 pr recvd vax & 20DEC woke up exp scratchy throat, aches & pains all over body, swollen glands, tiredness;21DEC94 sxs of the day a/intensified; 22DEC pt had earache as well as above; 23DEC woke w/hives all over body; 27DEC hives gone Y 12/12/1994 12/20/1994 8 NONE PVT PVT Ortho-Novum NONE NONE NONE

70656 01/17/1995 NJ 0.03 0 .3 M 01/11/1995 irritability, t103, very sleepy Y 01/10/1995 01/10/1995 0 PVT PVT

70657 01/17/1995 TN 66.07.00 66 F diarrhea started 14OCT93 the day p/the shot & cont for 12 days-gradually improving; Y 10/13/1994 10/14/1994 1 PVT UNK Cardene; Tenormin; NONE aortic aneurism, HBP, angio-edema-hives

70658 01/17/1995 TN 65.02.00 65 M 01/10/1995 pt exp severe upper resp infect for 30 days; it cleared up but persistent continuing h/a followed-still present-3 months later; N 10/13/1994 10/16/1994 3 CAT Scan of brain-sl sinus inflamation PVT PVT Lanoxin, Tenormin, nasa cort atrial fibrillation; pollen, mold, dust allergy

72347 01/17/1995 AZ 0.04 0 .4 M 12/08/1994 pt recvd vax; 3" hives at site, then progressed to gen hives;most resolved by 22aug94; U 08/19/1994 08/19/1994 0 UNK UNK CO5509

72350 01/17/1995 OH 0.06 F 12/08/1994 pt recvd vax; screamed for 2 days; recovered Y Y 08/25/1994 08/25/1994 0 PVT PUB none none none none CO5528

72351 01/17/1995 OH 0.03 M 12/08/1994 pt recvd vax; bulging fontanelle; seen in er & released; recovered; Y Y 08/29/1994 08/30/1994 1 PVT PUB none none none none CO5529

72354 01/17/1995 IL 0.09 0 .9 M 12/08/1994 pt recvd vax; wide spread rash on back,arms,abdo described by mom as small bumps which were not red & had no drainage; no fever;given vax given despite URI sxs because behind on 6 mon doses; Y 06/20/1994 06/20/1994 0 OTH PUB premature @ 35wks GA, w/resp distress; mild URI w/ low grade fever 100.9 none CO5596

70659 01/18/1995 NC 30.03.00 30 M 01/04/1995 fever, myalgias, arthralgia & facial nerve (CN VII) paralysis (bell's palsy); WBC 13,200 sed rate 59; PHS 23K; alk 0 73/AST 23; glu 80/lyte WNL; hgb 14.9;residual facial paralysis; Y N 12/27/1994 12/27/1994 0 UA neg; WBC 17,400 PUB UNK NONE NONE wasp venon NONE NC95005

70661 01/18/1995 CA 1.06 1 .6 M 01/12/1995 crying consistently for 3 1/2 hrs, stopped for 2 1/2 hrs, restarted for 4 hrs; Y U 01/11/1995 01/11/1995 0 NONE PVT PVT NONE NONE pt exp swelling to leg @ 6 mos w/DTP #3

70662 01/18/1995 NH 1.05 1 .5 M 01/12/1995 pain & swelling @ the site of DTP inject @ lt thigh w/in 1 hr p/vax; pt was quite fussy all day crying if not held; did not want to stand or walk; sx resolved the following morning; Y Y 12/27/1994 12/27/1994 0 PVT PUB NONE NONE NONE

70663 01/18/1995 NM 37.07.00 37 M 06/03/1994 pt recvd vax 24MAY94 & states that evening felt some arthritic pain in fingers; this cont until 27MAY94 when fingers swelled to the point couldn't bend them & ha signifcant pain; went to ER on 28MAY94 states it was considered an allerg; Y 05/24/1994 05/24/1994 0 UNK UNK

70664 01/18/1995 PA 0.02 0 .2 M 01/10/1995 pt devel fever, stridor, cough on evening of having been given vax; clinical dx was croup; Y 12/02/1994 12/02/1994 0 NA PVT PVT NA NONE NONE NONE

70665 01/18/1995 WI 41.03.00 41 F pt had erythema around deltoid lt area w/rash on chest & arm lt; Y 12/19/1994 12/19/1994 0 NONE PVT PVT NONE due for tetanus allergic to contrast dye NONE

70666 01/18/1995 WI 1.00 1 .0 M 01/13/1995 kicking of legs, red face, poss trouble breathing, afterwards was tired & pale; no tx sought I phoned nurse & MD who did not think it was related; 5 days later an allergy test showed poss allergy to eggs; Y 12/16/1994 12/16/1994 0 PVT PVT NA ear infection pt was tested p/vax for possble egg allergy NA

70667 01/19/1995 36.00.00 36 M 01/17/1995 GI upset, severe muscle spasms, light headedness, tachycardia, chest tightness/SOB; tx 02 by facemask, DPH, Epi, Solu cortef IV, Toridol IV w/lactated ringers solution; febrile beginning 10PM day of event; hospitalized x 3 days & recovered Y Y 3 Y 11/08/1994 11/08/1994 0 MIL MIL NONE NONE NONE CO5788

70668 01/19/1995 U pt exp diarrhea, h/a, nausea, inc temp, vaginal bleeding small & large volumes; sx cont p/plane trip inc bruisability on calves; 11/28/1994 11/28/1994 0 UNK UNK non-confirmed back & foot injuries-bone scan poss MR necessary; poss microadenona pituitary;

70669 01/19/1995 NY 24.00.00 23 F 01/17/1995 GBS Y Y 14 10/14/1994 OTH PVT

70670 01/19/1995 CT 57.02.00 57 M 01/16/1995 GBS Y Y 7 Y 10/17/1994 10/26/1994 9 NONE PVT PVT Mevacor NONE hypercholesterolemia NONE

70671 01/19/1995 VA 1.05 1 .5 M 01/13/1995 pt had 30 second generalized sz w/inc fever; fever first documented 20 hrs p/shot given; Y Y 01/11/1995 01/12/1995 1 pt exam all WNL @ ER visit; PVT PVT APAP, children's motrin mild nasal congestion brachioplexopathy is segmental dystonia of rt arm-resolved; +-family hx febrile sz

70672 01/19/1995 NY 0.00 0 .0 F 12/22/1994 pt given vax & noted to have maculopap rash on forehead @ 1640 hrs given DPH for rash; Y 12/20/1994 12/20/1994 0 NONE PUB UNK NONE NONE NA

70673 01/19/1995 MA 56.05.00 56 F 01/13/1995 started w/sore throat, dizziness, sinus blocked-breathing wheezy-went to MD bronchitis cold; 10/21/1994 11/25/1994 35 PUB UNK

70674 01/19/1995 NJ 38.01.00 38 F site of inject red swollen area (size of saucer) on upper arm; Y 09/20/1994 09/22/1994 2 PUB PVT

70675 01/19/1995 IN 50.04.00 50 F 01/17/1995 pt called c/o vomiting, h/a, low fever p/inject #2; pt states had exact same problem w/1st inject same time frame; pt assumed coincidentally ahd the flu p/1st shot but when if recurred p/2nd pt reported it; Y 01/05/1995 01/12/1995 7 UNK UNK NONE mult chocolate, aged cheese, onions, MSG, peanut butter; pt exp vomit, h/a, fever @ 50 yrs old w/Engerix B dose #1

70680 01/20/1995 NY 22.00 21 M 01/06/1995 pt recvd vax; mac pap rash(face,back,neck,arm & leg); fever, malaise & itching; dx of chicken pox at hosp 6jan95 Y Y 12/28/1994 12/31/1994 3 PUB PUB none none none none BA95K002

70681 01/20/1995 IL 0.02 0 .2 F 01/09/1995 pt recvd vax;pt crying non stop since recving inject @ 9:30am; called in @ 1:30pm;MD notified;apap ordered prior to next day; not to recv any more pertussis; Y 01/06/1995 01/06/1995 0 none PUB PUB stuffy nose na none IL950002

70682 01/20/1995 ME 19.03 19 F 01/12/1995 pt recvd vax;on 17oct had a work injury,approx 24 hrs later awoke w/ fever of 102.9; c/o redness & soreness at site;tx w/ ATB;still c/o severe pain & tenderness at site;in er;tx w/ motrin,11jan95 area still tender touch,area black & blue; N 10/17/1994 10/18/1994 1 unk PUB PVT none none none none ME95002

70683 01/20/1995 MO 1.06 1 .6 M 01/09/1995 pt recvd vax; became fussy @ approx 7:30pm;fever, sz;shaking, cyanosis; 911 called;adm to hosp; pt sz at hosp x 10";tx w/ valium, kept overnoc for observation;tx w/ amoxicillin for ear infect; Y Y 1 Y 01/06/1995 01/06/1995 0 PUB PUB none none mom states sz at age 15 mo; none MO95006

70684 01/20/1995 MO 0.03 0 .3 M 01/09/1995 pt recvd vax;started screaming at 1pm till 3:45pm;would dose but if put down would scream again;8pm fell asleep & slept all noc;MD was called but did not see pt; Y 01/09/1995 01/09/1995 0 none PUB PUB none none 31 wks gestation MO95007

70685 01/20/1995 ND 0.02 0 .2 F 01/10/1995 pt recvd vax;1 1/2 p/ vax, began high pitched crying,lasted x 3 hrs;took 20 mins nap then began 1 1/2 hrs of high pitched crying; t 101; lt leg swollen; apap given; attempted to put cold on swollen leg; Y 12/27/1994 12/27/1994 0 na PUB PUB none none none ND95001

70686 01/20/1995 OH 37.04.00 37 F 12/15/1994 pt recvd vax;muscular/skeletal could not move neck w/out severe discomfort & pain; Ibuprofen for discomfort & pain;MD advised 3 pills per day; Y N 11/17/1994 11/20/1994 3 OTH PVT none none none none OH95001

70688 01/20/1995 OK 1.07 1 .7 F 12/29/1994 pt recvd vax;at 6pm had sz,lasting approx 30 secs;taken to hosp;blood test,urine tests done, CT scan done;CT scan neg; MD planning on doing EEG later,mom does not think pt has fever before sz;no more sz at this time; 12/28/1994 12/28/1994 0 PUB PUB none none none none OK9474

70689 01/20/1995 OK 0.02 0 .2 M 01/10/1995 pt recvd vax; unexplained death; SIDS; Y 01/10/1995 N 12/21/1994 autopsy PUB PUB none none OK951

70690 01/20/1995 FL 0.01 0 .1 M 01/10/1995 pt recvd vax; high fever & irritability; Y 3 Y 12/03/1994 12/03/1994 0 PVT PUB well none

70691 01/20/1995 MO 0.04 0 .4 F 01/09/1995 pt recvd vax; generalized sz w/ fever < 24 hrs p/ vax; nl lytes-septic w/u neg including LP Y 1 Y 12/16/1994 12/17/1994 1 HCT, PIT-WNL UA neg;lytes WNL;CBC-WBC 17.8800 13B/54S PVT PVT none none none none

70692 01/20/1995 AZ 79.09.00 79 F 01/12/1995 pt recvd vax;n,ha,fever,d,aching bones 3-4 days p/ shot;saw MD;gave rx, pt not aware of what med was;cont to have cough,tired & some occasional n;infl virus pos; Y Y 11/16/1994 11/19/1994 3 SMAC,cardiac risk;CBC,thyroid, Infl A virus pos;had lab test,unsure about what type; PUB PUB none none per pt none in pt,had flu vax 2-3 yrs ago w/ sxs

70693 01/20/1995 CA 0.05 0 .5 M 01/13/1995 pt recvd vax; screaming, crying for 3-4 hrs Y Y 01/12/1995 01/12/1995 0 none PVT PVT acetaminophen none none

70694 01/20/1995 MI 61.05.00 61 F 01/12/1995 pt recvd vax; approx 6 hrs later had n w/ emesis; t 100; general achiness; still cont approx 24 hrs later; Y N 01/09/1995 01/09/1995 0 physical exam unremarkable PVT PVT fenoprofen none claim past rxn to flu vax;

70695 01/20/1995 NY 1.05 1 .5 M 01/03/1995 pt recvd vax;fever about 101;apap given;about 1pm sz; to hosp about 6pm;IV given w/ atb,motrin,apap;pt released when fever went down at about 12:30am;next day pt was fine Y Y 12/15/1994 12/24/1994 9 PVT OTH none none none

70696 01/20/1995 ID 1.01 1 .1 M 12/10/1994 pt recvd vax;running fever;began to seize w/ limb stiffness & mild intermittent tonic clonic movements;resolved 3-5 mins;all of sxs occured around 20 hrs p/ vax; Y 12/09/1994 12/10/1994 1 none PUB UNK morphine, apap burns, URI none none

70697 01/20/1995 IN 43.02.00 43 F 01/13/1995 pt recvd vax; arm swelling, redness, pain; Y 12/27/1994 PVT OTH prinivil,orthotricyclen, oxybutyrin; NONE allergies PCN, Sulfa, Valium

70698 01/20/1995 AL 32.00.00 F 01/10/1995 pt recvd vax;approx 20 mins later c/o n,faintness,pounding heart rate,pale;sxs subsided p/10 mins;cont to exp shaking chills;hot flashes;BP=140/60;MR=112 RR20;c/o fatigue,drowsiness,neck pain;sxs subsided p/ 3 hrs;to notify MD;hx of NKA; U 01/09/1995 01/09/1995 0 none OTH PVT none na na na

70699 01/20/1995 FL 0.04 0 .4 F 01/13/1995 pt recvd vax;had t of 105 per mom,noc of vax;returned to clinic 13jan95 for exam; Y 01/08/1995 01/08/1995 0 na OTH OTH apap none none none

70700 01/20/1995 OH 47.01.00 47 F 01/13/1995 pt recvd vax;area of induration/erythema (approx 3x5cm) on lt arm around inject site on 19dec94; starting approx 24-48 hrs p/ inject; Y 12/13/1994 12/14/1994 1 PVT UNK

70701 01/20/1995 OH 34.01.00 34 F 01/13/1995 pt recvd vax;soreness at site by next am;devel redness/induration starting 12jan95 & progressively inc;approx 3cm in diam;mild n, no emesis on am of 12jan95; 01/10/1995 01/12/1995 2 PVT PVT none none none

70704 01/23/1995 NY 32.00.00 32 M 01/18/1995 temporally related sz p/4th dose in series; CAT scan neg; State HD called by psychiatrist 13SEP94; pt currently on several psychotropic drugs; f/u pt had grand mal type sz 1/2 hr p/vax; was taken to hosp & CAT Scan; EEG nl; Y Y 08/30/1994 08/30/1994 0 OTH OTH mental retardation past history of HEB B, alcohol & drug abuse CO5547

70705 01/23/1995 IN 46.06.00 46 F 01/18/1995 h/a; severe enough that needed to lie down in the evening of 7NOV994; also had general malaise; c/o h/a started the same day of vax 4NOV94; 10NOV94 pt exp sz, then passed out; sx ruptured cerebral aneurysm; pt had surgery 11NOV94 & died; Y 11/17/1994 Y N 11/04/1994 11/04/1994 0 OTH OTH NONE heart condition not requiring medication CO5678

70706 01/23/1995 FL 0.02 0 .2 F 01/10/1995 pt came in for well baby check during morning-given vax & mom returned to clinic afternoon stating pt had been screaming from 11AM to 2PM-brief nap for 5 mins; Y Y 01/10/1995 01/10/1995 0 NONE OTH PUB NONE thrush, mild ? suspect gastroesophageal reflux FL95001

70707 01/23/1995 FL 55.00.00 54 M 01/03/1995 GBS-no strengh; numbness & tingling 9 fingers rt foot- 2 & 3rd toes, upper gum numb, weakness problem swallowing, nose numb, tongue, top lip numb, nerve ripples up neck to head; Y N 11/15/1994 12/03/1994 18 nerve conduct 22DEC94 studies; OTH PUB Uricet K NONE kidney stones, borderline, HTN FL95002

70708 01/23/1995 MS 1.05 1 .5 F 01/13/1995 mom called & stated that pt was vaxed 10JAN95 & had no problems but today 13JAN95 nursery called & told mom that pt was crying loudly-rt eye swollen & red blotches to face; pt was a little warm; mom told pt scratched cornea; Y Y 01/10/1995 01/13/1995 3 PUB PVT NONE NONE NONE NA MS95001

70709 01/23/1995 NC 0.01 0 .1 F 01/12/1995 virtually constant crying for 3-4 days that began 12 hrs p/shots given; Y 11/08/1994 11/08/1994 0 NONE PUB PUB NONE NONE NONE NC95006

70710 01/23/1995 NC 1.04 1 .4 M 01/11/1995 very irritable @ 5PM; didn't sleep well; next day had temp of 101; did not want to move or picked up; only moves hands; no severe local reactions; seen by MD 11JAN95; had ear infect; advised DTAP next time; Y Y 01/10/1995 01/11/1995 1 PUB UNK NONE NONE NC95007

70711 01/23/1995 NC 0.03 0 .3 M 01/11/1995 redness @ site of inject w/ a long red knot extending downward for about 1-1 1/2" from inject site; no pain, fever, or edema of surrounding tissue; advised warm water bath 11JAN95; pt improved; Y 01/09/1995 01/10/1995 1 PUB PUB NONE NONE NC95008

70712 01/23/1995 NC 0.05 0 .5 M 01/11/1995 rash started to devel w/in 24 hrs; red areas popped up w/whelps all over body; seen @ clinic-given rx drops for allerg react; rash would come & go-cleared up Y Y 01/03/1995 01/04/1995 1 PUB PUB NONE NONE NONE NC95009

70713 01/23/1995 NV 27.07.00 27 M 12/03/1994 c/o generalized body malaise which progressed to weakness w/high grade temp, chest congestion, coughing & inability to do physical works; pt took Amoxicillin, felt somehow better, but went to see MD & given Augmentin & Dexamethasone shot; Y Y 10/12/1994 10/14/1994 2 NA PUB PUB NONE NONE NONE NOE NV94031

70714 01/23/1995 NV 28.09.00 28 F 11/30/1994 hands stiff & thumbs hurt to squeeze things-spine achy, also neck (where spine is) rib cage kind of hurts)- no fever- fatigue-feet & hips ache-advised to seek medical care if sx persist; pts son had OPV vax same day; U 11/22/1994 11/27/1994 5 PUB PUB Ortho 77-birth controls NA allergic to PCN-Rheumatic fever as child NV94032

70715 01/23/1995 OH 0.07 0 .7 M 01/09/1995 pt looked flushed on 4DEC94 aorund 4PM; Sunday 4DEC94 evening noticed light rash all over face; 5DEC94 morning bright red bumps covered entire body which lasted 2 1/2 wks; face started peeling @ this time; had fever x 3 hrs; scratching face Y 12/02/1994 12/04/1994 2 PUB PUB NONE NONE NONE OH950003

70716 01/23/1995 OH 60.00.00 60 M 01/10/1995 same day vax given pt slept in truck overnoc & went fishing all day the following day; pt noted numbness upper posterior arm & pinching sensation to elbow; pt stated had associated pain @ sites also; seen by MD tx by chiropractor w/heat; Y U 11/15/1994 11/17/1994 2 NONE PUB PUB unk NONE NONE OH95004

70717 01/23/1995 SC 0.04 0 .4 F 10/18/1994 mom stated p/vax 23AUG94 5PM pt became very agitated & restless w/unconsolable shrill loud cry lasting approx until 9PM; mom informed MD of occurence @ next visit scheduled that same week; request of record sent; mom stated MD advised DT Y 08/23/1994 08/23/1994 0 PUB PUB NONE NONE NONE pt exp cry 2 hrs @ 2mo w/DTP #1; SC95002

70718 01/23/1995 SC 0.02 0 .2 M 12/14/1994 pts mom stated that p/vax pt began screaming & crying; mom states pt would not eat & cried constantly; mom stated walked the floor w/pt for over 4 hrs; gave pt APAP & used warm compresses lt thigh; t101 ax; pt finally fell asleep was fussy; Y 11/02/1994 11/02/1994 0 NA PUB PUB NONE NONE NA SC95003

70719 01/23/1995 SC 1.02 1 .2 F 01/16/1995 pt recvd vax & woke up felt real warm-mom gave some more APAP; pt was thirsty & asked for water; pt went back to sleep; pt was fretful; real stiff-legs stiff, eyes looked funny & white stiff & was coming out of mouth; Y Y 1 Y 01/12/1995 01/12/1995 0 PUB UNK NONE NONE SC95004

70720 01/23/1995 UT 1.00 0 1 F 01/13/1995 pt recvd vax 140PM 12JAN95 & @ 11AM 13JAN95 mom called & said that pt had been sleeping since given vax w/difficulty arousing; temp during the noc 102 & @ 8AM t102 & given APAP; inject site swollen, red, & warm; U 01/12/1995 01/12/1995 0 PUB PUB NONE pt's sibling exp szs @ 4mos w/DTP #1 UT951301

70721 01/23/1995 UT 13.01 13 M 01/06/1995 pale, dizzy & weak approx 1 min p/inject; had pt lie on floor x 10mins; Y 01/05/1995 01/05/1995 0 NONE PUB UNK NONE NONE NONE NONE UT952702

70722 01/23/1995 MS 0.02 0 .2 F 01/19/1995 2 hrs 15mins p/vax turned white as a sheet as mom was putting in infant seat; pt seen 50mins later; pt was pale & grunting w/cool, clammy, mottled dusky skin & temp of 102 R, viral infection-; LP was done & was adm to hosp; Y Y 3 Y 01/12/1995 01/12/1995 0 PVT PVT NONE recent cough-exam nl NONE x/in hosp discharge summary; NONE

70723 01/23/1995 CT 0.02 0 .2 F 01/19/1995 pt arrived @ ER DOA: Y 01/13/1995 Y N 01/13/1995 01/13/1995 0 PVT PUB well 2mo old NONE

70724 01/23/1995 FL 0.02 0 .2 F 12/10/1994 pt recvd 1st vax on 1SEP94 & was sl irritable the 1st day then reveted back to nl self next day or two; weight gain slowed down briefly for 1 wk, then picked up again; also exp tonic sz x 30 seconds; also exp poor feeding; Y N 09/01/1994 09/04/1994 3 EEG, MRI PVT PVT NONE NONE

70725 01/23/1995 NY 4.00 4 M 01/11/1995 5 mins p/vax pt began to cough, w/inc secretions then began to wheeze & exp bilateral eyelid edema; pt sx responded quickly to Epi, Albuterol, DPH & Pred; Y Y 1 Y 01/10/1995 01/10/1995 0 quick response of anaphylaxis to SQ EPi, DPH & albuterol neb given Pred as well; PVT PVT stuffy nose only hx of asthma-mild

70726 01/23/1995 FL 0.04 0 .4 M 01/19/1995 seizure & fever 102.0; Y Y 2 Y 01/17/1995 01/17/1995 0 PVT PUB Lasix, Digoxin heart murmur

70727 01/23/1995 NC 20.04 20 M 01/17/1995 pt recvd vax & returned in 40 mins c/o dizziness; administered 02 via nasal cannula, & 50mg inject of DPH & Epi; taken to hosp; pt adm & discharged; Y Y 1 Y 01/10/1995 01/10/1995 0 MIL MIL NONE NONE NONE

70728 01/23/1995 NY 1.03 1 .3 M 01/16/1995 seen in ER that noc for apnea, probably obstructive; Y Y Y 01/13/1995 01/13/1995 0 OTH PVT URI

70729 01/23/1995 WY 43.02.00 43 F 01/11/1995 @ time of inject, site burned & was red; blotches @ inject site, itching all over, small rash on back, red papules on back & arms, flushed & hot skin, 2 1/2 hrs p/inject; pt had just finished eating ham, broccoli & cheese casserole; Y Y 12/02/1994 12/02/1994 0 PUB PUB PCN-seasonal (pollen, hayfever)

70730 01/23/1995 12.05 12 U 01/16/1995 pt recvd vax;p/ vax became diaphoretic,pale & hypotensive;911 called; to er & then discharged; Y Y 01/16/1995 01/16/1995 0 PUB UNK none allergies to morphine & pcn; OH95006

70731 01/23/1995 69.07.00 69 M pt recvd vax;to er w/ erythema & induration on rt arm around inject site;pcn given for possible cellulitis17nov94 condition much improved;pt was attributed to an adverse rxn & cellulitis was ruled out; Y 11/14/1994 UNK UNK prophylaxis

70732 01/23/1995 NJ 0.02 0 .2 M 01/18/1995 pt recvd vax; fever 102.9; urticarial rash Y 01/11/1995 01/13/1995 2 CBC-WBC 9.0; HGB 8.6; PVT PVT none none none

70733 01/23/1995 WI 1.02 1 .2 M 01/15/1994 pt recvd vax; high fever 3-5 days p/ shot;t 106,ear thermometer;1 wk later rash occured,lasted 3 1/2 days; MD said it was Roseolla; Y Y 07/19/1994 07/22/1994 3 PUB OTH none none WI94120

70734 01/23/1995 VT 2.00 1 1 F 01/17/1995 pt recvd vax;on phenobarbital for afebrile szs;no sz since start of phenobarbital in apr94;had afebrile sz 24 hrs p/ vax; no fever,no local rxn; Y Y 01/09/1995 01/10/1995 1 phenobarbital level - 21.7(therapeutic) PVT PUB phenobarbital none sz disorder-afebrile

70735 01/23/1995 IL 0.07 0 .7 M 01/19/1995 pt recvd vax;mom got up & noted pt was afebrile & shaking;not jerking;became limp;no fever;meds given since bedtime;never jerked turned blue or became completely unresponsive;to er,dx w/ otitis med;T 102; Y Y 01/17/1995 01/18/1995 1 Blood cultures done; PVT PUB none none

70736 01/23/1995 IL 1.03 1 .3 F 01/13/1995 pt recvd vax; 12jan pt woke screaming, knees drawn up, fists clenched;t 100-101, holding breath for 10 secs, rapid heart beat rate; episode lasted 3 hrs; Y Y 01/12/1995 01/12/1995 0 none PVT UNK none none none

70737 01/23/1995 IL 2.04 M 01/12/1995 pt recvd vax;exp rash & edema of eyes & lips; Y U 01/11/1995 UNK UNK pcn VK;

70738 01/23/1995 MN 25.08.00 25 F 01/18/1995 pt recvd vax;arm very itchy & swollen; OK by 18jan; advised to consult MD before getting 3rd dose; Y 01/11/1995 none OTH PUB none none none none

70739 01/23/1995 AZ 0.04 0 .4 M 01/18/1995 pt recvd vax;crying & grenting for several hrs;mom states that on ?oce, he would stiffen then relax; no sz activity Y 01/17/1995 01/17/1995 0 PUB OTH none none none AZ9502

70740 01/23/1995 UT 0.00 0 .0 F 11/10/1994 pt recvd vax; at about 18 hrs of age devel intractable focal rt sided sz;dilantin & phenobarb given;subsequent eval has shown focal EEG,a nonspecific MRI,both on the rt w/ sz on lt;tx w/ atb's & acyclovir for full courses; U 10/11/1994 10/12/1994 1 EEG, MRI PUB PVT none none

70741 01/23/1995 FL 35.02.00 35 F 01/18/1995 pt recvd vax;15jan c/o flu-like sxs,ha,numbness lt side head behind ear;17jan seen PMD,has enlarged lymph gland lt side; MMR rxn; 18jan improving; 01/06/1995 01/15/1995 9 none PUB UNK none none none none FL95006

70742 01/23/1995 IL 70.06.00 70 F 12/28/1994 pt recvd vax;sxs began 4th day p/ vax; feeling like she was going to pass out;pounding all over body;"jumping muscles";heart palpitations;legs ache;difficulty swallowing;n & weakness;shortness of breath; Y 11/04/1994 11/08/1994 4 PVT PVT hypertension

70743 01/23/1995 WI 52.05.00 52 F 01/17/1995 pt recvd vax;entire upper arm, red, raised, and warm to touch; Y 01/11/1995 01/12/1995 1 na PVT PVT Mantoux by connaught; none none

70744 01/23/1995 TX 0.03 0 .3 M 01/18/1995 pt recvd vax;1 hr p/ vax began w/ a cry,more forceful,higher pitched & louder than usual;unconsolable for 4 hrs;13dec94,16 hrs total;seen 14dec in f/u w/ an unremarkable exam,fontanell was soft;no recurrence to date Y 12/12/1994 12/12/1994 0 none PVT PVT bethanecal, mylanta, Fer in-sol; 1 wk URI,bilat hernias gastroesophageal reflux,probable obstructive apnea none

70745 01/23/1995 CO 0.03 0 .3 F 01/14/1995 pt recvd vax; 3 days later, noted torticollis to R which resolved; no fever; acting fine;only mild local rxn; not examined & no tx; Y 12/20/1994 12/23/1994 3 none PVT PVT none none none none

70746 01/23/1995 PA 0.02 M 01/18/1995 pt recvd vax;excessive irritability w/ shrill cry for more than 4 hrs p/ vax; Y 08/23/1994 08/23/1994 0 none OTH PUB nystatin susp & cream thrush none none PA9511

70747 01/23/1995 NY 23.04 23 F 01/17/1995 pt recvd vax; exp itchyness, reddish papules over upper arm around inject site x few hrs, but resolved;malaise,fatigue,aches still persist; 01/09/1995 01/13/1995 4 29dec94 Rubella susceptible; OTH PVT none none none

70748 01/23/1995 NY 0.02 0 .2 F 01/18/1995 pt recvd vax; excessive crying for more than 3 hrs, same day of vax; Y 11/16/1994 11/16/1994 0 PVT PVT none none none in brother,crying & high fever w/ 1 dose of DTP at yrs 2 & 3 dose of dtp at yrs;

70749 01/23/1995 CA F 01/18/1995 pt recvd vax;mac pap erythematous pruritic rash 1 day p/ vax; Y na PVT PVT premarin none HTN, asthma

70750 01/23/1995 FL 76.07.00 76 M 01/12/1995 pt recvd vax;claimed been unsteady on feet U 11/23/1994 PVT PVT

70751 01/23/1995 OH 0.03 0 .3 M pt recvd vax; high pitched cry, arching of back; Y 01/17/1995 PVT PVT congenital CMV

70752 01/23/1995 MN 41.04.00 41 F 01/17/1995 pt recvd vax; n; weakness fron 23nov to 25nov;pt sought no med tx; bedrest Y 11/23/1994 11/23/1994 0 PVT PVT investigational drug

70753 01/23/1995 WV 0.04 0 .4 F 01/03/1995 pt recvd vax; t above 105; Y 11/07/1994 11/08/1994 1 PVT PVT none none

70754 01/24/1995 CT 36.01.00 36 F pt recvd vax;c/o soreness in lt arm from elbow to shoulder,progressed in severity;could not raise arm above shoulder;no redness,no decoloration;23jan95 still slightly sore Y 01/11/1995 01/12/1995 1 none OTH PVT na na na CT9502

70755 01/24/1995 10.00 U 01/14/1995 pt recvd vax;adm to hosp due to dec activity & pancreatitis (amylase 650,lipase>1700);t of 99.5;recovered,no tx x/ acetaminophen;devel mild systemic rxn(fever, arthralgia) to Rubella vax & pancreatitis due to MMR vax; Y 12/28/1994 01/11/1995 14 UNK UNK San Fillipo synd

70756 01/24/1995 FL 3.00 3 F 01/20/1995 pt recvd vax; devel fever of 101 ax, swollen leg, large red "hives" area over inject site;given motrin & rxn subsided over next 48 hrs; Y Y 01/17/1995 01/18/1995 1 PVT PVT none none none

70757 01/24/1995 PA 0.03 0 .3 M 01/21/1995 pt recvd vax;at 2pm began screaming,emesis x 4;t 100; was fussy;seen in ofc,moaning at times but alert;total screaming x 4 hrs;back to nl in 24 hrs; Y Y 12/28/1994 12/28/1994 0 PVT PVT apap none none

70758 01/24/1995 PA 66.07.00 66 M 01/21/1995 pt recvd vax;double vision, 3 days following flu & pneumonia shot;tested pos for myasthenia gravis Y N 10/11/1994 10/14/1994 3 MRI, EMG,blood test, CAT scan; OTH OTH none none none

70759 01/24/1995 CA 1.03 1 .3 F 01/20/1995 pt recvd vax; devel fever,leg pain 16jan95;fever persisted thru 20jan95, reaching 106 at least twice;19jan95 devel erythematous papular rash; Y N 01/03/1995 01/16/1995 13 underwent septic workup;hip ultra sound, all neg; PVT PVT nalproic acid, nitrazapen; none infantile spasms, severe develop. delay;

70760 01/24/1995 CA 0.02 0 .2 F 01/18/1995 pt recvd vax;2 wks later,dry spots appeared on skin;1st in the bends of her arms, now all over body;when new spots breaks out pt gets sick; MD said it was a rash Y 12/01/1994 12/15/1994 14 PUB PVT na na na

70761 01/24/1995 MN 0.04 0 .4 F 01/18/1995 pt recvd vax;t 105.3 R eve of vax;grunting,pallor,cyanosis,unresponsive,shaking of limbs (not jerking);d;acute episode of shaking x 5 mins; N 01/17/1995 01/17/1995 0 none PVT PVT none diarrhea none none

70762 01/24/1995 NJ 1.04 1 .4 F 01/19/1995 pt recvd vax;cyanotic spell that lasted 30 secs acompanied by rolling eyes & shaking mvmts of extremities;fever of 102; Y 01/18/1995 01/18/1995 0 PVT UNK OM & monilia diaper rash none

70763 01/24/1995 CA 1.01 1 .1 M 01/18/1995 pt recvd vax; onset 14jan;exp rash,red raised,variably shaped maculo;some target lesions & areas of conference; Y 01/06/1995 01/14/1995 8 none PVT PVT amoxil otitis med

70764 01/24/1995 SD 0.02 0 .2 M 01/16/1995 pt recvd vax;4 hrs later mom reports shallow breathing noted & redness lasting 15 mins over entire body & face;no crying;no fever;no er visit Y 11/07/1994 11/07/1994 0 none PVT PUB none none none

70765 01/24/1995 CA 0.06 0 .6 M 01/19/1995 pt recvd vax;devel fever 103;area of erythema & sl swelling 5x3 cm at site of inject on lt leg; irritability; Y 01/17/1995 01/17/1995 0 none PVT PVT amoxicillin resolving otitis med none in pt, fever & irritability w/ dpt by hx;

70766 01/24/1995 FL 0.02 0 .2 M 01/19/1995 pt recvd vax;lt leg where vax adm,very red & very swollen;had high pitched uncontrollable crying for over 3 hrs per mom; Y 01/17/1995 01/17/1995 0 none PVT PVT none none none none

70767 01/24/1995 PA 0.02 0 .2 M 01/11/1995 pt recvd vax;exp episodes of high pitched crying in the 5 days since vax adm; Y 01/05/1995 01/06/1995 1 PVT PVT none none

70768 01/24/1995 CO 0.04 0 .4 F 01/19/1995 immed 3/4" redness @ DTP site Y 01/19/1995 01/19/1995 0 PVT PVT NONE NONE NONE CO5797

70769 01/24/1995 CO 0.02 0 .2 M 01/19/1995 pt recvd vax;immed p/ area became inflammed,confluent flat,warm to touch otherwise nl;area approx 1 1/4" diam;ice applied x 15 mins;no longer warm,dec area of erythema to 1/2" diam diffuse; Y 01/19/1995 01/19/1995 0 none PVT PVT none none none

70770 01/25/1995 FL 0.02 0 .2 F 01/13/1995 pt recvd vax; fine macular rash all over body, hands,face, feet,trunk,arms,legs;blanches w/ pressure; rash appeared 12 hrs p/ vax; 01/10/1995 PUB PUB caldesine powder, tristat creme monilial diaper rash FL95004

70771 01/25/1995 GA 0.07 0 .7 F 08/26/1994 pt recvd vax;mom states redness at site;size of quarter;began to spread p/ several hrs;25aug whole thigh covered;to MD 25aug; MD states leg infected;on pcn x 10 days;mom states leg improving now; Y Y 08/24/1994 08/24/1994