chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 51.0
Sex: M
Vaccine: FLU3
Symptoms: Malaise, Mean cell haemoglobin concentration, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume decreased
Clinical narrative: See attachment; 11/07/2007, 2:00 p.m. - chills and fever temp 101, 2 tabs tylenlol 500mg every 6 hours; 11/08/2007 - chills and fever temp 101, muscle aches; 11/09/2007 - chills and fever 102, muscle ache and headache, alternating 2 tabs tylenol 500 mg and 2 tabs motrin 800 mg every 6 hours; 11/10/2007 - chills and fever temp 102, muscle ache, headache, hoarseness; 11/11/2007 - chills and fever temp 102, muscle ache, headache, hoarseness; 11/12/2007 - chills and fever temp 102, muscle ache, headache, hoarseness, and small and large hives appearing on hand, arms, and front, back, and sides of body. 11/13/2007, 5:00 a.m. - chills and fever temp 101, muscle ache, headache, hoarsenss; small and large hives connecting which made both arms and hands large and puffy with hives; face and eyes with large and puffy with hives. 8:00 a.m. went to hospital emergency room at Community Hospital. Given pain medication and benadryl through I.V.. Hives subsides. Diagnosed "flu shot side effects,". 11/14/2007 to 11/17/2007 - sick in bed, stayed home, and continued to take medications prescribed by doctor, 2 tabs benadryl every 4 hours, 1 tab motrin 800 mg 3 times daily. 11/18/2007 - fully recovered. 11/19/2007 - back to work.
Age: 51.0
Sex: M
Vaccine: FLU3
Symptoms: Monocyte count decreased, Myalgia, Neutrophil count normal, Platelet count decreased, Pyrexia
Clinical narrative: See attachment; 11/07/2007, 2:00 p.m. - chills and fever temp 101, 2 tabs tylenlol 500mg every 6 hours; 11/08/2007 - chills and fever temp 101, muscle aches; 11/09/2007 - chills and fever 102, muscle ache and headache, alternating 2 tabs tylenol 500 mg and 2 tabs motrin 800 mg every 6 hours; 11/10/2007 - chills and fever temp 102, muscle ache, headache, hoarseness; 11/11/2007 - chills and fever temp 102, muscle ache, headache, hoarseness; 11/12/2007 - chills and fever temp 102, muscle ache, headache, hoarseness, and small and large hives appearing on hand, arms, and front, back, and sides of body. 11/13/2007, 5:00 a.m. - chills and fever temp 101, muscle ache, headache, hoarsenss; small and large hives connecting which made both arms and hands large and puffy with hives; face and eyes with large and puffy with hives. 8:00 a.m. went to hospital emergency room at Community Hospital. Given pain medication and benadryl through I.V.. Hives subsides. Diagnosed "flu shot side effects,". 11/14/2007 to 11/17/2007 - sick in bed, stayed home, and continued to take medications prescribed by doctor, 2 tabs benadryl every 4 hours, 1 tab motrin 800 mg 3 times daily. 11/18/2007 - fully recovered. 11/19/2007 - back to work.
Age: 51.0
Sex: M
Vaccine: FLU3
Symptoms: Red blood cell count normal, Red cell distribution width normal, Swelling face, Urticaria, White blood cell count normal
Clinical narrative: See attachment; 11/07/2007, 2:00 p.m. - chills and fever temp 101, 2 tabs tylenlol 500mg every 6 hours; 11/08/2007 - chills and fever temp 101, muscle aches; 11/09/2007 - chills and fever 102, muscle ache and headache, alternating 2 tabs tylenol 500 mg and 2 tabs motrin 800 mg every 6 hours; 11/10/2007 - chills and fever temp 102, muscle ache, headache, hoarseness; 11/11/2007 - chills and fever temp 102, muscle ache, headache, hoarseness; 11/12/2007 - chills and fever temp 102, muscle ache, headache, hoarseness, and small and large hives appearing on hand, arms, and front, back, and sides of body. 11/13/2007, 5:00 a.m. - chills and fever temp 101, muscle ache, headache, hoarsenss; small and large hives connecting which made both arms and hands large and puffy with hives; face and eyes with large and puffy with hives. 8:00 a.m. went to hospital emergency room at Community Hospital. Given pain medication and benadryl through I.V.. Hives subsides. Diagnosed "flu shot side effects,". 11/14/2007 to 11/17/2007 - sick in bed, stayed home, and continued to take medications prescribed by doctor, 2 tabs benadryl every 4 hours, 1 tab motrin 800 mg 3 times daily. 11/18/2007 - fully recovered. 11/19/2007 - back to work.
Age: 52.0
Sex: F
Vaccine: FLU3
Symptoms: Mobility decreased, Pain in extremity
Clinical narrative: Continued soreness in arm.  Limited mobility due to pain.  Dr.-warm compresses IB.
Age: 14.0
Sex: F
Vaccine: FLU3
Symptoms: Chest X-ray normal, Chest discomfort, Dizziness, Dyspnoea, Full blood count normal
Clinical narrative: Within 15 min., had nausea and dizziness - 10 min later had shortness of breath and heaviness in chest - went to ER - had nebulizer tx - s/s resolved - the next am had renewed s/s - went to ER for 2nd Neb Tx- Recovered.
Age: 14.0
Sex: F
Vaccine: FLU3
Symptoms: Nausea
Clinical narrative: Within 15 min., had nausea and dizziness - 10 min later had shortness of breath and heaviness in chest - went to ER - had nebulizer tx - s/s resolved - the next am had renewed s/s - went to ER for 2nd Neb Tx- Recovered.
Age: 62.0
Sex: M
Vaccine: FLU3
Symptoms: Injection site pain, Insomnia
Clinical narrative: She has had persistent pain at site of injection. Significant enough that she's not been able to sleep normally due to pain. No signs of infection or inflammation.
Age: 23.0
Sex: F
Vaccine: HPV4
Symptoms: Dizziness
Clinical narrative: After receiving HPV vaccine/Gardasil (her 3rd dose) patient felt lightheaded; she reclined on exam table. No loss of consciousness, took sips of water, waited about 15 min, B/P monitored. Left ambulatory.
Age: 1.26
Sex: M
Vaccine: DTAP, FLU3, HIBV, PNC
Symptoms: Injection site pain, Injection site swelling
Clinical narrative: 3cm Bilat Swelling thighs, no fever, mild pain able to walk and run
Age: 14.0
Sex: F
Vaccine: FLU3
Symptoms: Rash generalised, Viral rash
Clinical narrative: APPROXIMATELY 2 DAYS AFTER VACCINE ADMINISTRATION PATIENT DEVELOPED A RASH ON ENTIRE BODY DESCRIBED BY MD AS VIRAL EXANTHUM,
Age: 71.0
Sex: M
Vaccine: FLU3
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Injection site swelling
Clinical narrative: States got flu shot 10/31/07 - States he showered but did not remove bandaid until next morning - then noticed red "itchy" bumpy area. States area around shot was also swollen. The red bumpy area on 11/05/07 was in area of padded part of bandaid - States he has latex allergy but bandaids weren't latex ones. 11-7-07 called him - States it is better he did stop by Dr's office on 11-5-07
Age: 65.0
Sex: F
Vaccine: FLU3
Symptoms: Activities of daily living impaired, Injected limb mobility decreased, Pain in extremity, Sleep disorder
Clinical narrative: Flu shot on Wed afternoon - Arm little sore am of next day. But worse as days went on. Kept her up during the night. Took Tylenol about 7pm (Thurs) states can't raise arm. Took more Tylenol at 11pm. Elevated in chair with ice pack 2 more Tylenol At 2am and more at 530 am. Had to have husband help her dress. Spoke to her on 11/16/07. States that it went away the next day and she is ok. She did not contact Dr. (family).
Age: 62.0
Sex: F
Vaccine: PPV, TTOX
Symptoms: Musculoskeletal pain, Nausea, White blood cell count increased
Clinical narrative: Right shoulder pain, nausea
Age: 0.2
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC, RV5
Symptoms: Rash generalised, Vaccine positive rechallenge
Clinical narrative: 2m - 7-18-07 - after shots that Night - pt broke out in Rash - was taken to E.R. - rash 4-m - 9-18-07 - after Shot's - this time more severe Large area over body - taken to E.R.
Age: 47.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Dizziness, Dyspnoea, Nausea
Clinical narrative: Dizziness, Nausea, Difficulty Breathing Pt. was prescribed Ativan at the emergency room.
Age: 65.0
Sex: F
Vaccine: FLU3
Symptoms: Blood pressure, Dizziness, Heart rate normal, Immediate post-injection reaction, Injection site erythema
Clinical narrative: Had redness and swelling at injection site (Lt deltoid) immediately after injection was given.  Also has slight dizziness.  B/P-140/90, pulse 64.  Re-checked patient at 9:30AM B/P-144/92, pulse-66.  There was less redness and swelling at injection site.  Patient feeling good except for slight dizziness.  Checked again at 11:00AM B/P-138/88, pulse 72.  Feeling good.  No pain or redness at injection site.  Still very slight dizziness.  Instructed to see MD if dizziness continues or has any other symptoms.
Age: 65.0
Sex: F
Vaccine: FLU3
Symptoms: Injection site swelling
Clinical narrative: Had redness and swelling at injection site (Lt deltoid) immediately after injection was given.  Also has slight dizziness.  B/P-140/90, pulse 64.  Re-checked patient at 9:30AM B/P-144/92, pulse-66.  There was less redness and swelling at injection site.  Patient feeling good except for slight dizziness.  Checked again at 11:00AM B/P-138/88, pulse 72.  Feeling good.  No pain or redness at injection site.  Still very slight dizziness.  Instructed to see MD if dizziness continues or has any other symptoms.
Age: 0.9
Sex: F
Vaccine: FLU3
Symptoms: Inappropriate schedule of drug administration, Medication error
Clinical narrative: 2nd dose of influenza admin. 4 days early.  Appt not listed as 2nd dose.  Parent never stated this was 2nd dose.
Age: 0.5
Sex: M
Vaccine: DTAP, HBHEPB, IPV, PNC, RV5
Symptoms: Diarrhoea
Clinical narrative: Diarrhea for 5 days.
Age: 51.0
Sex: M
Vaccine: FLU3, PPV
Symptoms: Chest discomfort, Chills, Lymph node pain, Lymphadenopathy, Pain
Clinical narrative: Within 15 minutes of receiving injection, felt chest tightness.  (Did not return to clinic.)  Lasted a few minutes.  In evening felt feverish, aching & had chills until fever broke in the night.  R underarm lymph nodes swollen & tender, lasted 48-60 hours.  No treatment sought.
Age: 51.0
Sex: M
Vaccine: FLU3, PPV
Symptoms: Pyrexia
Clinical narrative: Within 15 minutes of receiving injection, felt chest tightness.  (Did not return to clinic.)  Lasted a few minutes.  In evening felt feverish, aching & had chills until fever broke in the night.  R underarm lymph nodes swollen & tender, lasted 48-60 hours.  No treatment sought.
Age: 56.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Arthralgia, Erythema, Lymph node pain, Lymphadenopathy, Pain
Clinical narrative: Fever, aches, joint pain developed within 9 hours.  Fever broke during the night.  R underarm lymph nodes swollen (palpable) & tender 3 days.  36 hours after vaccine noted 2" reddened circular area near armpit.  All symptoms resolved 4 days post injection.  No treatment sought.
Age: 56.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Pyrexia
Clinical narrative: Fever, aches, joint pain developed within 9 hours.  Fever broke during the night.  R underarm lymph nodes swollen (palpable) & tender 3 days.  36 hours after vaccine noted 2" reddened circular area near armpit.  All symptoms resolved 4 days post injection.  No treatment sought.
Age: 54.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Anxiety, Arthralgia, Chest discomfort, Nail discolouration, Pain
Clinical narrative: Noted black coloration (like dirt or oil) of knuckles & fingernails of both hands, could not be washed off.  Felt "tight chest", anxious in afternoon & evening.  Black coloration lasted 48 hours, no treatment sought.  On 11/7/07, 5 days post vaccine administration, patient reports feeling "worse than ever" - sore throat, joint pain (especially neck & shoulders).  Taking ibuprofen regularly.  On 11/8/07, 6 days post vaccine, patient reports symptoms no better; aching all over; shoulders & neck very painful.  Fever last night 100 degrees.  Encouraged to see Dr. - will do so on 11/9/07 if not feeling better.
Age: 54.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Pharyngolaryngeal pain, Pyrexia, Skin discolouration
Clinical narrative: Noted black coloration (like dirt or oil) of knuckles & fingernails of both hands, could not be washed off.  Felt "tight chest", anxious in afternoon & evening.  Black coloration lasted 48 hours, no treatment sought.  On 11/7/07, 5 days post vaccine administration, patient reports feeling "worse than ever" - sore throat, joint pain (especially neck & shoulders).  Taking ibuprofen regularly.  On 11/8/07, 6 days post vaccine, patient reports symptoms no better; aching all over; shoulders & neck very painful.  Fever last night 100 degrees.  Encouraged to see Dr. - will do so on 11/9/07 if not feeling better.
Age: 60.0
Sex: F
Vaccine: TDAP
Symptoms: Blood pressure, Chills, Erythema, Headache, Heart rate normal
Clinical narrative: Adacel given 11/16/07, 11/17 arm started to hurt, also nausea & headache.  11/18 - worse arm pain, fever & chills.  11/19 worse arm pain, redness, swelling.  11/20 more redness, saw MD, red area 21 cm & nearly wraps around upper arm.  98.4, 88, 140/84.  Rx'd Alavert 1/2 & Duricef 500 1 bid x10d.
Age: 60.0
Sex: F
Vaccine: TDAP
Symptoms: Nausea, Pain in extremity, Pyrexia, Swelling
Clinical narrative: Adacel given 11/16/07, 11/17 arm started to hurt, also nausea & headache.  11/18 - worse arm pain, fever & chills.  11/19 worse arm pain, redness, swelling.  11/20 more redness, saw MD, red area 21 cm & nearly wraps around upper arm.  98.4, 88, 140/84.  Rx'd Alavert 1/2 & Duricef 500 1 bid x10d.
Age: 57.0
Sex: F
Vaccine: TDAP
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling
Clinical narrative: Site red, swollen, indurated.  Itchy.
Age: 17.0
Sex: F
Vaccine: HPV4
Symptoms: Dizziness, Headache
Clinical narrative: Headache and dizziness after vaccine.  Pt was given the vaccine lying down.  She waited in the office 20-25 min lying down for 20 min., sitting up for 5 min.
Age: 76.0
Sex: F
Vaccine: FLU3
Symptoms: Anticoagulant therapy, Skin discolouration
Clinical narrative: On Oct. 17, 2007 patient requested to be given flu shot with other staff of the dental clinic.  I accommodated all of them (5 staff and gave flu shots).  After about 4 days patient came to the clinic and showed me her arms with bluish discoloration.  Advice given to go to her PMD.  She informed me that she is on Coumadin for 1 yr. already.
Age: 3.0
Sex: M
Vaccine: FLU3
Symptoms: Aggression, Decreased appetite, Enuresis, Speech disorder
Clinical narrative: Per mom, bedwetting, decreased appetite, mumbling, speech deficit, increased temper tantrums.
Age: 36.0
Sex: M
Vaccine: FLU3, PPV
Symptoms: Injection site erythema, Injection site pain, Injection site streaking, Mobility decreased, Pain
Clinical narrative: Reported pain & decreased mobility the evening of the injection.  By the next morning a raised red "line" developed from the injection site into the left armpit.  The line was very tender.  All symptoms gone by 4th day post injection.  No treatment sought.
Age: 12.0
Sex: F
Vaccine: FLU3, HPV4, MNQ, TDAP
Symptoms: Dizziness, Nausea, Vomiting
Clinical narrative: Nausea, dizziness & vomiting during 12-24 hours after vaccines.
Age: 40.0
Sex: F
Vaccine: FLU3
Symptoms: Hypoaesthesia, Mobility decreased, Pain in extremity, Paraesthesia
Clinical narrative: Pain and numbness in arm.  Began when shot was given and is continuing.  Has difficulty lifting arm and tingling esp. at night.
Age: 52.0
Sex: F
Vaccine: FLU3
Symptoms: Hemiparesis
Clinical narrative: Left sided weakness.
Age: 40.0
Sex: F
Vaccine: FLU3
Symptoms: Injection site erythema, Injection site induration, Injection site oedema, Injection site pruritus, Injection site swelling
Clinical narrative: swelling, redness, itching and mild edema induration at site. large. Benadryl po; Ice
Age: 25.0
Sex: F
Vaccine: HEP
Symptoms: Dysgeusia, Laboratory test, Nausea, Vomiting
Clinical narrative: 11/20/08 Hep vaccine administered.  11/21/07 patient reported to work feeling nauseated & advertently threw up multiple times V.S.  Labs-WNL.  She reported that she is not pregnant.  N/V resolved 11/21.  c/o "metallic & acidy" taste in her throat & mouth 11/23.
Age: 69.0
Sex: M
Vaccine: PPV
Symptoms: Erythema, Local reaction, Oedema
Clinical narrative: Local reaction with erythema, edema.
Age: 75.0
Sex: M
Vaccine: PPV
Symptoms: Erythema
Clinical narrative: Erythema circumferential, distal to injection site.  Advised to take Benadryl or Allegra.
Age: 75.0
Sex: F
Vaccine: PPV
Symptoms: Erythema
Clinical narrative: Erythema distal to injection site.
Age: 28.0
Sex: U
Vaccine: HEP
Symptoms: Anxiety, Heart rate increased, Hyperhidrosis, Nausea, Syncope vasovagal
Clinical narrative: Sweaty, anxious, increased HR 92-100, mild tremors, nauseated.
Age: 28.0
Sex: U
Vaccine: HEP
Symptoms: Tremor
Clinical narrative: Sweaty, anxious, increased HR 92-100, mild tremors, nauseated.
Age: 11.0
Sex: M
Vaccine: VARCEL
Symptoms: Cellulitis, Injection site erythema, Injection site swelling
Clinical narrative: Pt developed cellulitis morning after injection.  Redness and swelling at injection site.
Age: 41.0
Sex: F
Vaccine: DTAP
Symptoms: Mobility decreased
Clinical narrative: States lost over 50% ROM in L arm S/P DTaP.  Has regained approx 95% of ROM at this time (11/15/07).
Age: 41.0
Sex: F
Vaccine: DTAP
Symptoms: Pain, Skin warm
Clinical narrative: Site of injection L arm. c/o L hand hot, deep ache forearm to wrist.  DTaP.
Age: 59.0
Sex: F
Vaccine: UNK
Symptoms: Bronchitis, Condition aggravated, Fatigue, Headache, Nausea
Clinical narrative: Headache, nausea, fatigue-couldn't eat because of nausea, fever. Cough from nearly-healed bronchitis recurred
Age: 59.0
Sex: F
Vaccine: UNK
Symptoms: Pyrexia
Clinical narrative: Headache, nausea, fatigue-couldn't eat because of nausea, fever. Cough from nearly-healed bronchitis recurred
Age: 5.0
Sex: F
Vaccine: DTAP, IPV, MMR, VARCEL
Symptoms: Varicella post vaccine
Clinical narrative: Varicella disease 50-500 lesions.
Age: 9.0
Sex: M
Vaccine: HEPA, VARCEL
Symptoms: Erythema, Oedema peripheral
Clinical narrative: Back of arm very red, swollen.
Age: 1.0
Sex: F
Vaccine: HIBV, MMR, PNC, VARCEL
Symptoms: Injection site erythema, Injection site infection, Injection site papule, Injection site pruritus, Injection site swelling
Clinical narrative: Rt. thigh site infected, on ABT for infection.  Very red, swollen, central papule with 1 vesicle, s/ itches of erythema.
Age: 1.0
Sex: F
Vaccine: HIBV, MMR, PNC, VARCEL
Symptoms: Injection site vesicles
Clinical narrative: Rt. thigh site infected, on ABT for infection.  Very red, swollen, central papule with 1 vesicle, s/ itches of erythema.
Age: 71.0
Sex: M
Vaccine: PPV
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
Clinical narrative: Swelling, redness, heat L arm.  Started 1 day after vaccine administered.
Age: 5.0
Sex: M
Vaccine: VARCEL
Symptoms: Inappropriate schedule of drug administration
Clinical narrative: Pt. given a 3rd varicella vaccination.
Age: 0.7
Sex: F
Vaccine: IPV, PNC
Symptoms: Febrile convulsion, Pyrexia
Clinical narrative: Child developed fever 4 hrs after vaccine administered.  She had a seizure 14 hrs after receiving the vaccine.  Seen in ER & did well.
Age: 1.0
Sex: F
Vaccine: HEP, HIBV, MMR, VARCEL
Symptoms: Blister, Varicella, Varicella post vaccine
Clinical narrative: Woke up on 11-14-07 with fluid filled blister on waist & belly.  Child seen 11-14-07, Dx with chicken pox.
Age: 1.1
Sex: F
Vaccine: MMR, PNC, VARCEL
Symptoms: Rash
Clinical narrative: Rash on abd x8 days.
Age: 4.0
Sex: F
Vaccine: HIBV, MMR, PNC, VARCEL
Symptoms: Rash
Clinical narrative: Seen 11-8-07 D/T rash on chest, back & face that comes & goes for x3 weeks.
Age: 23.0
Sex: F
Vaccine: RAB, RAB
Symptoms: Abdominal pain, Activated partial thromboplastin time, Dizziness, Haemoglobin, Monocyte count
Clinical narrative: A 23 year old student received a single dose of rabies vaccine on November 7, 2007 at 8:15 a.m.  Three hours later presented dizziness, nausea, vomit and abdominal pain.  Patient vital signs were observed for one hour and discharged home in stable condition.  Twelve hours later, she had to be evaluated at the emergency room when she presented generalized urticarial rash and pruritus.  No respiratory distress was referred.
Age: 23.0
Sex: F
Vaccine: RAB, RAB
Symptoms: Nausea, Pruritus, Rash generalised, Urticaria, Vomiting
Clinical narrative: A 23 year old student received a single dose of rabies vaccine on November 7, 2007 at 8:15 a.m.  Three hours later presented dizziness, nausea, vomit and abdominal pain.  Patient vital signs were observed for one hour and discharged home in stable condition.  Twelve hours later, she had to be evaluated at the emergency room when she presented generalized urticarial rash and pruritus.  No respiratory distress was referred.
Age: 23.0
Sex: F
Vaccine: RAB, RAB
Symptoms: White blood cell count
Clinical narrative: A 23 year old student received a single dose of rabies vaccine on November 7, 2007 at 8:15 a.m.  Three hours later presented dizziness, nausea, vomit and abdominal pain.  Patient vital signs were observed for one hour and discharged home in stable condition.  Twelve hours later, she had to be evaluated at the emergency room when she presented generalized urticarial rash and pruritus.  No respiratory distress was referred.
Age: 23.0
Sex: F
Vaccine: RAB, RAB
Symptoms: Abdominal pain, Dizziness, Haemoglobin decreased, Monocyte count increased, Nausea
Clinical narrative: A 23 year old student received a single dose of rabies vaccine on November 7, 2007 at 8:15 a.m.  Three hours later presented dizziness, nausea, vomit and abdominal pain.  Patient vital signs were observed for one hour and discharged home in stable condition.  Twelve hours later, she had to be evaluated at the emergency room when she presented generalized urticarial rash and pruritus.  No respiratory distress was referred.
Age: 23.0
Sex: F
Vaccine: RAB, RAB
Symptoms: Platelet count normal, Pruritus, Urticaria, Vomiting, White blood cell count
Clinical narrative: A 23 year old student received a single dose of rabies vaccine on November 7, 2007 at 8:15 a.m.  Three hours later presented dizziness, nausea, vomit and abdominal pain.  Patient vital signs were observed for one hour and discharged home in stable condition.  Twelve hours later, she had to be evaluated at the emergency room when she presented generalized urticarial rash and pruritus.  No respiratory distress was referred.
Age: 66.0
Sex: F
Vaccine: PPV
Symptoms: Injected limb mobility decreased, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling
Clinical narrative: Pt. c/o swollen, red, painful left deltoid.  Area feels warm to touch and hard area around injection site.  Pt. unable to lift left arm above head.  Shot given at 5:00 pm and c/o reaction starting at 8:00 pm.  Saw physician next day and got Cephalexin 500 mg tid x5 days, Claritin 10 mg daily x1 day.
Age: 66.0
Sex: F
Vaccine: PPV
Symptoms: Injection site warmth
Clinical narrative: Pt. c/o swollen, red, painful left deltoid.  Area feels warm to touch and hard area around injection site.  Pt. unable to lift left arm above head.  Shot given at 5:00 pm and c/o reaction starting at 8:00 pm.  Saw physician next day and got Cephalexin 500 mg tid x5 days, Claritin 10 mg daily x1 day.
Age: 14.0
Sex: F
Vaccine: HPV4, TD
Symptoms: Anorexia, Aphthous stomatitis, Dehydration, Gingivitis, Malaise
Clinical narrative: PATIENT HAD SX 1 DAY AFTER VACCINATIONS GIVEN LASTING 7 DAYS TOTAL. SHE HAD CONSTANT FEVERS X1WK RANGING FROM 99-104 DEGREES. MALAISE, NAUSEA, ANOREXIA, SORE THROAT, DEHYDRATION, GRAY COLORED MEMBRAINE ON THROAT ON DAY 5 OF 7, DEVELOPED CANCRE SORES IN MOUTH, INFLAMED GUMS, RECEIVED IV FLUIDS AS OUTPT X3 (1000CC BAGS), USED IBUPROFEN & ACETAMINOPHEN FOR FEVER, USED LIDOCAINE SWISH FOR SORE MOUTH, HYDROGEN PEROXIDE/H2O 50-50% SWISH FOR SORE GUMS,  COMPAZINE FOR NAUSEA, ZITHROMAX RX ON DAY 5 OF 7.
Age: 14.0
Sex: F
Vaccine: HPV4, TD
Symptoms: Nausea, Pharyngolaryngeal pain, Pyrexia
Clinical narrative: PATIENT HAD SX 1 DAY AFTER VACCINATIONS GIVEN LASTING 7 DAYS TOTAL. SHE HAD CONSTANT FEVERS X1WK RANGING FROM 99-104 DEGREES. MALAISE, NAUSEA, ANOREXIA, SORE THROAT, DEHYDRATION, GRAY COLORED MEMBRAINE ON THROAT ON DAY 5 OF 7, DEVELOPED CANCRE SORES IN MOUTH, INFLAMED GUMS, RECEIVED IV FLUIDS AS OUTPT X3 (1000CC BAGS), USED IBUPROFEN & ACETAMINOPHEN FOR FEVER, USED LIDOCAINE SWISH FOR SORE MOUTH, HYDROGEN PEROXIDE/H2O 50-50% SWISH FOR SORE GUMS,  COMPAZINE FOR NAUSEA, ZITHROMAX RX ON DAY 5 OF 7.
Age: 0.17
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC
Symptoms: Rash
Clinical narrative: Patient developed a rash on both thighs where vaccines were administered.  Vaccines were given 11/06/07.  Rash appeared 11/07/07 and lasted until 11/13/07. RAsh appeared as small, round, bumps on the anterior/lateral thigh.
Age: 67.0
Sex: M
Vaccine: FLUX
Symptoms: Headache, Malaise, Nausea
Clinical narrative: Received shot on Thrusday 15 Nov 2007. Sick to the stomach, nausua, and continuous headache to date.
Age: 8.0
Sex: F
Vaccine: FLU3
Symptoms: Inappropriate schedule of drug administration, Medication error, Wrong drug administered
Clinical narrative: None. Vaccine not approved for age group.
Age: 16.0
Sex: F
Vaccine: FLU3
Symptoms: Inappropriate schedule of drug administration, Medication error, Wrong drug administered
Clinical narrative: None. Vaccine not approved for age group.
Age: 14.0
Sex: F
Vaccine: FLU3
Symptoms: Inappropriate schedule of drug administration, Medication error, Wrong drug administered
Clinical narrative: None. Vaccine not approved for age group.
Age: 13.0
Sex: F
Vaccine: FLU3
Symptoms: Inappropriate schedule of drug administration, Medication error, Wrong drug administered
Clinical narrative: None. Vaccine not approved for age group.
Age: 72.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site rash
Clinical narrative: Rash at injection site
Age: 1.25
Sex: M
Vaccine: DTAP, FLU3, HIBV
Symptoms: Febrile convulsion, Full blood count, Laboratory test
Clinical narrative: The patient had a fever and apparent febrile seizure within 24 hours of having immunizations.
Age: 59.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Erythema, Oedema peripheral, Pain in extremity
Clinical narrative: SWOLLEN, PAINFUL ARM, RED STREAKS ON ARM - OCCURED DAY AFTER VACCINE WAS ADMINISTERED. PATIENT WENT TO ER, ER DOC GAVE SHOT OF ANTIBIOTIC (PER PATIENT)AND SENT HER WITH A PRESCRIPTION FOR CEPHALEXIN 500MG FOUR TIMES DAILY AND INSTRUCTIONS TO FOLLOW UP WITH HER FAMILY PHYSICIAN.  PATIENT HAS AN APPOINTMENT WITH FAMILY DOC MONDAY (5 DAYS AFTER EVENT).
Age: 4.0
Sex: M
Vaccine: DTAP, FLU3, IPV, MMR, VARCEL
Symptoms: Chest X-ray normal, Chest pain, Dyspnoea, Injection site erythema, Lacrimation increased
Clinical narrative: Patient returned to clinic approximately 30 minutes after vaccines given due to chest pain, watery eyes, difficulty breathing that started about 10min after vaccines administered.  Very mild redness at site of varivax.  Patient was noted to be wheezing and was given an albuterol neb, prednisone and benadryl which seemed to relieve symptoms.
Age: 4.0
Sex: M
Vaccine: DTAP, FLU3, IPV, MMR, VARCEL
Symptoms: Wheezing
Clinical narrative: Patient returned to clinic approximately 30 minutes after vaccines given due to chest pain, watery eyes, difficulty breathing that started about 10min after vaccines administered.  Very mild redness at site of varivax.  Patient was noted to be wheezing and was given an albuterol neb, prednisone and benadryl which seemed to relieve symptoms.
Age: 91.0
Sex: F
Vaccine: FLUX
Symptoms: Deafness bilateral, Ear, nose and throat examination, Echocardiogram, Ultrasound scan
Clinical narrative: Mom lost hearing in both ears after receiving the flu short.  Her right ear has gradually regained hearing, but the hearing loss comes and goes.  Her left ear has shown some improvement, but limited.  Even though when she can, she isn't always able to comprehend what is being said.  She normally doesn't have a problem with hearing loss or understanding conversation.
Age: 46.0
Sex: F
Vaccine: TDAP
Symptoms: Blister, Burning sensation, Erythema, Oedema peripheral
Clinical narrative: Edema up to Shoulder of Left Arm with Blistering, Redness, "Fiery" feeling; Axilla. Blistering and Edematous - lasting 19 Days
Age: 0.2
Sex: M
Vaccine: DTAP, HEP, HIBV, PNC, RV5, DTAP, HEP, HIBV, PPV, RV5
Symptoms: Diarrhoea
Clinical narrative: He had his2 month vaccines on Oct 15th, 2007 - was given 5 vaccines on samedayMeningitisPneumoniaHep BDTPRotateq for RotavirusStarted developingwhite watery stools right after day of vaccination. Started losing alittle weight. Stools became more frequent 12+ a day. By Oct 21st he wasacutely dehydrated and rushed to the ER. He was put on IV. Hiselectrolytes were bad - low bicarbs and high potassium. His symptomsworsened and his stools would come out the minute he was fed (almostevery 30 minutes). The stools were white and watery. It almost lookedlike malabsorption. On 23rd Oct, his stools tested negative forRotavirus. He was placed on gut rest (just oral pediolyte) for 8 hourson Aug 24th. His condition slightly improved and his stools turnedyellow in color and slightly thicker (it was still watery) and lessfrequent (every hour and a half).By 27th Oct his stools were slightlythicker and his frequency was about once every 2 hours. He wasdischarged from the hospital and was asked to be placed underobservation at home.29th Oct morning again his stools became morefrequent and watery and he was rushed to the Hospital. He was placed on IV again and they ran a slew oftests for bacteria, parasites, viruses, etc and everything camenegative. His condition had not shown any improvement by the 1st ofNovember. His reducing substance test came positive (very high values).The Pediatric GE recommended putting him on a elemental formula(Elecare). Oral feeds of Elecare also did not help and his stools wouldcome out the minute he was fed. The stools looked more like what was fedso malabsorption was strongly suspected. So he was put on controlledfeeds through an NG tube on the 2nd of November AM (2cc per hour). Theyalso ruled out congenital deficiencies like Sodium Chloride deficiency,cystic fibrosis. They strongly suspected MVID or IED. By this time everyvein in his body was busted so they decided to put him on a central lineon the 2nd of November. An upper and lower endoscopy were also performedat the same time with multiple biopsies. He was tolerating these lowfeeds (2 cc an hour) through the NG tube. They came back on the 8th ofNovember and told us that it was not MVID and they were going to lookfor Auto Immune Disorders as they saw a lot of Eosinophils in theintestine. By this time his NG tube feeds were up to around 15 CC anhour. The doctors were upping the feeds at about 2-3 CC a day forsometime. Starting the 13th of November they were more aggressive withthe NG feeds and started upping it at 5 CC an hour. On Nov 15th, he wasup to 40 CC an hour and he was tolerating it. They removed the Central line on the 16th and started bolus oral feeds. On Nov 17th,  yankedout his NG tube so they decided not to put that in again. He wasdischarged on the 18th of Nov. He has been tolerating oral feeds of 4 Ozof Elecare every 3 hours. We are still waiting to see what the problem is, and if and when he can tolerate oral feeds of normal food.
Age: 0.2
Sex: M
Vaccine: DTAP, HEP, HIBV, PNC, RV5, DTAP, HEP, HIBV, PPV, RV5
Symptoms: Biopsy intestine abnormal, Dehydration, Diarrhoea, Endoscopy abnormal, Faeces discoloured
Clinical narrative: He had his2 month vaccines on Oct 15th, 2007 - was given 5 vaccines on samedayMeningitisPneumoniaHep BDTPRotateq for RotavirusStarted developingwhite watery stools right after day of vaccination. Started losing alittle weight. Stools became more frequent 12+ a day. By Oct 21st he wasacutely dehydrated and rushed to the ER. He was put on IV. Hiselectrolytes were bad - low bicarbs and high potassium. His symptomsworsened and his stools would come out the minute he was fed (almostevery 30 minutes). The stools were white and watery. It almost lookedlike malabsorption. On 23rd Oct, his stools tested negative forRotavirus. He was placed on gut rest (just oral pediolyte) for 8 hourson Aug 24th. His condition slightly improved and his stools turnedyellow in color and slightly thicker (it was still watery) and lessfrequent (every hour and a half).By 27th Oct his stools were slightlythicker and his frequency was about once every 2 hours. He wasdischarged from the hospital and was asked to be placed underobservation at home.29th Oct morning again his stools became morefrequent and watery and he was rushed to the Hospital. He was placed on IV again and they ran a slew oftests for bacteria, parasites, viruses, etc and everything camenegative. His condition had not shown any improvement by the 1st ofNovember. His reducing substance test came positive (very high values).The Pediatric GE recommended putting him on a elemental formula(Elecare). Oral feeds of Elecare also did not help and his stools wouldcome out the minute he was fed. The stools looked more like what was fedso malabsorption was strongly suspected. So he was put on controlledfeeds through an NG tube on the 2nd of November AM (2cc per hour). Theyalso ruled out congenital deficiencies like Sodium Chloride deficiency,cystic fibrosis. They strongly suspected MVID or IED. By this time everyvein in his body was busted so they decided to put him on a central lineon the 2nd of November. An upper and lower endoscopy were also performedat the same time with multiple biopsies. He was tolerating these lowfeeds (2 cc an hour) through the NG tube. They came back on the 8th ofNovember and told us that it was not MVID and they were going to lookfor Auto Immune Disorders as they saw a lot of Eosinophils in theintestine. By this time his NG tube feeds were up to around 15 CC anhour. The doctors were upping the feeds at about 2-3 CC a day forsometime. Starting the 13th of November they were more aggressive withthe NG feeds and started upping it at 5 CC an hour. On Nov 15th, he wasup to 40 CC an hour and he was tolerating it. They removed the Central line on the 16th and started bolus oral feeds. On Nov 17th,  yankedout his NG tube so they decided not to put that in again. He wasdischarged on the 18th of Nov. He has been tolerating oral feeds of 4 Ozof Elecare every 3 hours. We are still waiting to see what the problem is, and if and when he can tolerate oral feeds of normal food.
Age: 0.2
Sex: M
Vaccine: DTAP, HEP, HIBV, PNC, RV5, DTAP, HEP, HIBV, PPV, RV5
Symptoms: Faeces pale, Gastrointestinal tube insertion, Laboratory test, Rotavirus test negative, Weight decreased
Clinical narrative: He had his2 month vaccines on Oct 15th, 2007 - was given 5 vaccines on samedayMeningitisPneumoniaHep BDTPRotateq for RotavirusStarted developingwhite watery stools right after day of vaccination. Started losing alittle weight. Stools became more frequent 12+ a day. By Oct 21st he wasacutely dehydrated and rushed to the ER. He was put on IV. Hiselectrolytes were bad - low bicarbs and high potassium. His symptomsworsened and his stools would come out the minute he was fed (almostevery 30 minutes). The stools were white and watery. It almost lookedlike malabsorption. On 23rd Oct, his stools tested negative forRotavirus. He was placed on gut rest (just oral pediolyte) for 8 hourson Aug 24th. His condition slightly improved and his stools turnedyellow in color and slightly thicker (it was still watery) and lessfrequent (every hour and a half).By 27th Oct his stools were slightlythicker and his frequency was about once every 2 hours. He wasdischarged from the hospital and was asked to be placed underobservation at home.29th Oct morning again his stools became morefrequent and watery and he was rushed to the Hospital. He was placed on IV again and they ran a slew oftests for bacteria, parasites, viruses, etc and everything camenegative. His condition had not shown any improvement by the 1st ofNovember. His reducing substance test came positive (very high values).The Pediatric GE recommended putting him on a elemental formula(Elecare). Oral feeds of Elecare also did not help and his stools wouldcome out the minute he was fed. The stools looked more like what was fedso malabsorption was strongly suspected. So he was put on controlledfeeds through an NG tube on the 2nd of November AM (2cc per hour). Theyalso ruled out congenital deficiencies like Sodium Chloride deficiency,cystic fibrosis. They strongly suspected MVID or IED. By this time everyvein in his body was busted so they decided to put him on a central lineon the 2nd of November. An upper and lower endoscopy were also performedat the same time with multiple biopsies. He was tolerating these lowfeeds (2 cc an hour) through the NG tube. They came back on the 8th ofNovember and told us that it was not MVID and they were going to lookfor Auto Immune Disorders as they saw a lot of Eosinophils in theintestine. By this time his NG tube feeds were up to around 15 CC anhour. The doctors were upping the feeds at about 2-3 CC a day forsometime. Starting the 13th of November they were more aggressive withthe NG feeds and started upping it at 5 CC an hour. On Nov 15th, he wasup to 40 CC an hour and he was tolerating it. They removed the Central line on the 16th and started bolus oral feeds. On Nov 17th,  yankedout his NG tube so they decided not to put that in again. He wasdischarged on the 18th of Nov. He has been tolerating oral feeds of 4 Ozof Elecare every 3 hours. We are still waiting to see what the problem is, and if and when he can tolerate oral feeds of normal food.
Age: 16.0
Sex: F
Vaccine: TDAP
Symptoms: Erythema, Injected limb mobility decreased, Pain in extremity, Paraesthesia
Clinical narrative: On November 12, 2007, patient received in her left deltoid region, a Boostrix injection, Glaxo Smith Kline, lot number 52b016BA, expiration date of 03/30/09.  Patient and mother report she had soreness and redness of the left arm within 2 days of the injection.  She presents today, 11/24/07 with a complaint of left arm hurting after the shot with tingling off and on.  Physical exam revealed equal strength in hand grasps bilaterally.  Upper left arm range of motion painful.  Flexion of deltoid exhibited pain.  Patient reports she had used 800 mg of Ibuprofen without relief.  She continues to perform activities of daily living such as washing dishes and school activities.  She did report she dropped a book when she was handed a book. Treatment recommended today - Ibuprofen 600 mg every 6 hours.
Age: 57.0
Sex: F
Vaccine: FLU3
Symptoms: Injected limb mobility decreased, Pain
Clinical narrative: Shot was administered very high on the arm, practically in the shoulder socket or ligament.  Shot was extremely painful when administered.  I still have considerable pain in the shoulder/muscles, radiating down my back.  Movement is affected in that shoulder.  The pain comes and goes during the day, but is severe enough to wake me several times in the middle of the night.  I have continued to excercise and stretch the affected muscles but it is painful to do that.  I mentioned it to my doctor approx 2 weeks after the shot, who told me to continue to monitor it and continue stretching.  I really can't afford to go to an orthopedist at this time.
Age: 31.0
Sex: F
Vaccine: FLUX
Symptoms: Arthralgia, Blood test, Colonoscopy, Computerised tomogram, Convulsion
Clinical narrative: For several months I was going to the Doctor for cronic pain, numbness in my arms and constant nausea and dizziness.  Doctors tried to diagnose me with MS, Fibromyalgia and Cronic Fatige after months of blood tests and other testing.  None of these illness' fit my problems exactly and were all ruled out.  The illness began to spread into my nerves and I felt like I was having seizures, could not sleep at all - even with large dose sleeping pills and did not feel like myself.  After months of testing and nothing to help, I felt like I was dying a slow death.  The symptoms started to spread through my entire body.  At first only one side of my body was numb and had pains, it then spread to the other side.  I now have pains in every joint in my body.  I feel like I am 80 years old suffering from RA.  When I was very sick, I felt like I was being slowly poisioned.  I had the flu shot in October of 2006.  I was finally directed to a Doctor in the beginning of April who I feel saved my life.  He told me I had a form of Syrum sickness from the flu shot and immediately had me take Prednisone.  It took eight weeks of being on Prednisone before I began to feel like myself again.  The mini seizures have stopped now.  I have taken Prednisone for eight months now just to treat the symptoms and function in daily life.  I was not able to perform nomal tasks without this medication.  I am slowly weaning from the medication by reducing dosage 1mg a month.  I have been told to expect at least two years before symptoms to reduce.  At this point, I do not know what the long term permanent damage will be.  My 5 yr old son who also received a flue shot on the same day as me is also suffering similar aches and pains and problems that I encountered.  I have not felt his symptoms have been bad enough to justify the dangers of taking prednisone.  I hope more than anything his problems will correct themselves on their own.  I cannot stress enough that this has been the most miserable experience of my life.  I may never be the same again (or my son) just because I thought I was doing the right thing getting a Flu shot.  Please advise people on the dangers.  It is very real.
Age: 31.0
Sex: F
Vaccine: FLUX
Symptoms: Dizziness, Fatigue, Fibromyalgia, Hypoaesthesia, Insomnia
Clinical narrative: For several months I was going to the Doctor for cronic pain, numbness in my arms and constant nausea and dizziness.  Doctors tried to diagnose me with MS, Fibromyalgia and Cronic Fatige after months of blood tests and other testing.  None of these illness' fit my problems exactly and were all ruled out.  The illness began to spread into my nerves and I felt like I was having seizures, could not sleep at all - even with large dose sleeping pills and did not feel like myself.  After months of testing and nothing to help, I felt like I was dying a slow death.  The symptoms started to spread through my entire body.  At first only one side of my body was numb and had pains, it then spread to the other side.  I now have pains in every joint in my body.  I feel like I am 80 years old suffering from RA.  When I was very sick, I felt like I was being slowly poisioned.  I had the flu shot in October of 2006.  I was finally directed to a Doctor in the beginning of April who I feel saved my life.  He told me I had a form of Syrum sickness from the flu shot and immediately had me take Prednisone.  It took eight weeks of being on Prednisone before I began to feel like myself again.  The mini seizures have stopped now.  I have taken Prednisone for eight months now just to treat the symptoms and function in daily life.  I was not able to perform nomal tasks without this medication.  I am slowly weaning from the medication by reducing dosage 1mg a month.  I have been told to expect at least two years before symptoms to reduce.  At this point, I do not know what the long term permanent damage will be.  My 5 yr old son who also received a flue shot on the same day as me is also suffering similar aches and pains and problems that I encountered.  I have not felt his symptoms have been bad enough to justify the dangers of taking prednisone.  I hope more than anything his problems will correct themselves on their own.  I cannot stress enough that this has been the most miserable experience of my life.  I may never be the same again (or my son) just because I thought I was doing the right thing getting a Flu shot.  Please advise people on the dangers.  It is very real.
Age: 31.0
Sex: F
Vaccine: FLUX
Symptoms: Lumbar puncture, Multiple sclerosis, Nausea, Nuclear magnetic resonance imaging brain, Pain
Clinical narrative: For several months I was going to the Doctor for cronic pain, numbness in my arms and constant nausea and dizziness.  Doctors tried to diagnose me with MS, Fibromyalgia and Cronic Fatige after months of blood tests and other testing.  None of these illness' fit my problems exactly and were all ruled out.  The illness began to spread into my nerves and I felt like I was having seizures, could not sleep at all - even with large dose sleeping pills and did not feel like myself.  After months of testing and nothing to help, I felt like I was dying a slow death.  The symptoms started to spread through my entire body.  At first only one side of my body was numb and had pains, it then spread to the other side.  I now have pains in every joint in my body.  I feel like I am 80 years old suffering from RA.  When I was very sick, I felt like I was being slowly poisioned.  I had the flu shot in October of 2006.  I was finally directed to a Doctor in the beginning of April who I feel saved my life.  He told me I had a form of Syrum sickness from the flu shot and immediately had me take Prednisone.  It took eight weeks of being on Prednisone before I began to feel like myself again.  The mini seizures have stopped now.  I have taken Prednisone for eight months now just to treat the symptoms and function in daily life.  I was not able to perform nomal tasks without this medication.  I am slowly weaning from the medication by reducing dosage 1mg a month.  I have been told to expect at least two years before symptoms to reduce.  At this point, I do not know what the long term permanent damage will be.  My 5 yr old son who also received a flue shot on the same day as me is also suffering similar aches and pains and problems that I encountered.  I have not felt his symptoms have been bad enough to justify the dangers of taking prednisone.  I hope more than anything his problems will correct themselves on their own.  I cannot stress enough that this has been the most miserable experience of my life.  I may never be the same again (or my son) just because I thought I was doing the right thing getting a Flu shot.  Please advise people on the dangers.  It is very real.
Age: 31.0
Sex: F
Vaccine: FLUX
Symptoms: Serum sickness
Clinical narrative: For several months I was going to the Doctor for cronic pain, numbness in my arms and constant nausea and dizziness.  Doctors tried to diagnose me with MS, Fibromyalgia and Cronic Fatige after months of blood tests and other testing.  None of these illness' fit my problems exactly and were all ruled out.  The illness began to spread into my nerves and I felt like I was having seizures, could not sleep at all - even with large dose sleeping pills and did not feel like myself.  After months of testing and nothing to help, I felt like I was dying a slow death.  The symptoms started to spread through my entire body.  At first only one side of my body was numb and had pains, it then spread to the other side.  I now have pains in every joint in my body.  I feel like I am 80 years old suffering from RA.  When I was very sick, I felt like I was being slowly poisioned.  I had the flu shot in October of 2006.  I was finally directed to a Doctor in the beginning of April who I feel saved my life.  He told me I had a form of Syrum sickness from the flu shot and immediately had me take Prednisone.  It took eight weeks of being on Prednisone before I began to feel like myself again.  The mini seizures have stopped now.  I have taken Prednisone for eight months now just to treat the symptoms and function in daily life.  I was not able to perform nomal tasks without this medication.  I am slowly weaning from the medication by reducing dosage 1mg a month.  I have been told to expect at least two years before symptoms to reduce.  At this point, I do not know what the long term permanent damage will be.  My 5 yr old son who also received a flue shot on the same day as me is also suffering similar aches and pains and problems that I encountered.  I have not felt his symptoms have been bad enough to justify the dangers of taking prednisone.  I hope more than anything his problems will correct themselves on their own.  I cannot stress enough that this has been the most miserable experience of my life.  I may never be the same again (or my son) just because I thought I was doing the right thing getting a Flu shot.  Please advise people on the dangers.  It is very real.