chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 83.0
Sex: M
Vaccine: VARZOS, VARZOS, VARZOS
Symptoms: Convulsion, Electrocardiogram, Nuclear magnetic resonance imaging, Positron emission tomogram
Clinical narrative: On 3-31-09 I received a shingles shot. On 04-02-09 I had a generalized tonic clonic seizure. Hospitalized. EEG, PET scan and MRI done to establish the diagnosis.
Age: 83.0
Sex: M
Vaccine: VARZOS, VARZOS, VARZOS
Symptoms: Electroencephalogram, Grand mal convulsion, Nuclear magnetic resonance imaging, Positron emission tomogram normal
Clinical narrative: On 3-31-09 I received a shingles shot. On 04-02-09 I had a generalized tonic clonic seizure. Hospitalized. EEG, PET scan and MRI done to establish the diagnosis.
Age: 83.0
Sex: M
Vaccine: VARZOS, VARZOS, VARZOS
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Nuclear magnetic resonance imaging, Positron emission tomogram normal
Clinical narrative: On 3-31-09 I received a shingles shot. On 04-02-09 I had a generalized tonic clonic seizure. Hospitalized. EEG, PET scan and MRI done to establish the diagnosis.
Age: 18.0
Sex: F
Vaccine: MEN, MNQ
Symptoms: Asthenia, Chest discomfort, Cough, Dizziness, Dyspnoea
Clinical narrative: On 4/28/09 the patient was given the meningitis vaccine:  Meningococcal (MENACTRA) Polysaccharide accination injection given in the left deltoid by RN who then realized after vaccine was given that the expiration date was: actually 4/11/09 The Lot#:  u2560aa Expiration Date:  4/11/09 Manufacturer:  Sanofi Pasteur. The next day, pt's mother called reporting that pt did not feel well. She was not sure if it was due to the vaccine. She subsequently developed fatigue, malaise and fever to 102.5 F. She was seen in office on 5/2/09 had labs and throat cx ordered. On 5/4/09, she developed a cough and CXR was ordered which demonstrated left lingular and left lower lobe pneumonia. She was treated with Cipro 500 mg twice daily x 10days and repeat CXR on 5/11/09 showed interval improvement in pneumonia. She is better now.
Age: 18.0
Sex: F
Vaccine: MEN, MNQ
Symptoms: Pallor, Pyrexia, Vomiting
Clinical narrative: On 4/28/09 the patient was given the meningitis vaccine:  Meningococcal (MENACTRA) Polysaccharide accination injection given in the left deltoid by RN who then realized after vaccine was given that the expiration date was: actually 4/11/09 The Lot#:  u2560aa Expiration Date:  4/11/09 Manufacturer:  Sanofi Pasteur. The next day, pt's mother called reporting that pt did not feel well. She was not sure if it was due to the vaccine. She subsequently developed fatigue, malaise and fever to 102.5 F. She was seen in office on 5/2/09 had labs and throat cx ordered. On 5/4/09, she developed a cough and CXR was ordered which demonstrated left lingular and left lower lobe pneumonia. She was treated with Cipro 500 mg twice daily x 10days and repeat CXR on 5/11/09 showed interval improvement in pneumonia. She is better now.
Age: 18.0
Sex: F
Vaccine: MEN, MNQ
Symptoms: Band neutrophil count, Chest X-ray abnormal, Cough, Expired drug administered, Fatigue
Clinical narrative: On 4/28/09 the patient was given the meningitis vaccine:  Meningococcal (MENACTRA) Polysaccharide accination injection given in the left deltoid by RN who then realized after vaccine was given that the expiration date was: actually 4/11/09 The Lot#:  u2560aa Expiration Date:  4/11/09 Manufacturer:  Sanofi Pasteur. The next day, pt's mother called reporting that pt did not feel well. She was not sure if it was due to the vaccine. She subsequently developed fatigue, malaise and fever to 102.5 F. She was seen in office on 5/2/09 had labs and throat cx ordered. On 5/4/09, she developed a cough and CXR was ordered which demonstrated left lingular and left lower lobe pneumonia. She was treated with Cipro 500 mg twice daily x 10days and repeat CXR on 5/11/09 showed interval improvement in pneumonia. She is better now.
Age: 18.0
Sex: F
Vaccine: MEN, MNQ
Symptoms: Lymphocyte percentage decreased, Malaise, Monocyte count increased, Neutrophil count, Pneumonia
Clinical narrative: On 4/28/09 the patient was given the meningitis vaccine:  Meningococcal (MENACTRA) Polysaccharide accination injection given in the left deltoid by RN who then realized after vaccine was given that the expiration date was: actually 4/11/09 The Lot#:  u2560aa Expiration Date:  4/11/09 Manufacturer:  Sanofi Pasteur. The next day, pt's mother called reporting that pt did not feel well. She was not sure if it was due to the vaccine. She subsequently developed fatigue, malaise and fever to 102.5 F. She was seen in office on 5/2/09 had labs and throat cx ordered. On 5/4/09, she developed a cough and CXR was ordered which demonstrated left lingular and left lower lobe pneumonia. She was treated with Cipro 500 mg twice daily x 10days and repeat CXR on 5/11/09 showed interval improvement in pneumonia. She is better now.
Age: 18.0
Sex: F
Vaccine: MEN, MNQ
Symptoms: Pyrexia, White blood cell count increased
Clinical narrative: On 4/28/09 the patient was given the meningitis vaccine:  Meningococcal (MENACTRA) Polysaccharide accination injection given in the left deltoid by RN who then realized after vaccine was given that the expiration date was: actually 4/11/09 The Lot#:  u2560aa Expiration Date:  4/11/09 Manufacturer:  Sanofi Pasteur. The next day, pt's mother called reporting that pt did not feel well. She was not sure if it was due to the vaccine. She subsequently developed fatigue, malaise and fever to 102.5 F. She was seen in office on 5/2/09 had labs and throat cx ordered. On 5/4/09, she developed a cough and CXR was ordered which demonstrated left lingular and left lower lobe pneumonia. She was treated with Cipro 500 mg twice daily x 10days and repeat CXR on 5/11/09 showed interval improvement in pneumonia. She is better now.
Age: 2.0
Sex: M
Vaccine: MMR
Symptoms: Abnormal behaviour, Autism, Convulsion, Feeling abnormal, Speech disorder
Clinical narrative: Information has been received from a consumer concerning her 24 month old nephew who was vaccinated with MMR II when he was 18 months old. Sometime after receiving the vaccine the patient started spacing. The patient had to have something in each hand. The patient did not have verbal skills. When the patient was 2 years old the physician's thought was that the patient was deaf. But then the physician diagnosed the patient with autism. It was reported that the patient was improved by doing therapy but was not 100%. At the time of reporting the 4 years old patient was having seizures at night time. The outcome of the patient's autism and seizure at night time were not reported. Upon internal review, autism and seizures were considered to be other important medical events. Additional information has been requested.
Age: 0.5
Sex: M
Vaccine: HEP
Symptoms: Abnormal behaviour, Autism, Electroencephalogram abnormal, Nuclear magnetic resonance imaging, Speech disorder developmental
Clinical narrative: Information has been received from a consumer concerning her 2 years old son with a history of cross-eyes operation who in November 2005, was vaccinated with RECOMBIVAX HB (lot # 648410/0489P). Secondary suspect therapy included hepatitis A virus vaccine inactivated (MSD) (lot # 656497/1231F) given in April 2007, VARIVAX (MSD) (lot # 652725/0249F) given in September 2006, PEDVAXHIB and MMR (manufacturer unknown). The patient was administered with other vaccines required up to his age including PREVNAR, TRIPEDIA, OPV-MERIEUX, IPV MERIEUX and three doses of influenza virus vaccine (unspecified). Concomitant therapy included multivitamin (unspecified). It was reported that when the patient was around 2 years old, he was diagnosed with autism. He can't say one word; he can't talk at 4 years old and has odd behaviors like slapping his hands all the time. Medical attention was sought and the patient "was seen". In February 2009 a urine test was performed which showed high levels of aluminum. The patient was undergoing weekly treatment to chealate aluminum, mercury, lead and nickel since February 2009. On an unspecified date an EEG was performed with abnormal result. An MRI was performed with inconclusive results. The patient's mother believes that any of the above vaccines with preservatives or aluminum may have contributed with his autism. At the time of reporting the patient had not recovered. Upon internal review autism was considered to be another important medical event. Additional information has been requested.
Age: 0.5
Sex: M
Vaccine: HEP
Symptoms: Urine aluminium increased
Clinical narrative: Information has been received from a consumer concerning her 2 years old son with a history of cross-eyes operation who in November 2005, was vaccinated with RECOMBIVAX HB (lot # 648410/0489P). Secondary suspect therapy included hepatitis A virus vaccine inactivated (MSD) (lot # 656497/1231F) given in April 2007, VARIVAX (MSD) (lot # 652725/0249F) given in September 2006, PEDVAXHIB and MMR (manufacturer unknown). The patient was administered with other vaccines required up to his age including PREVNAR, TRIPEDIA, OPV-MERIEUX, IPV MERIEUX and three doses of influenza virus vaccine (unspecified). Concomitant therapy included multivitamin (unspecified). It was reported that when the patient was around 2 years old, he was diagnosed with autism. He can't say one word; he can't talk at 4 years old and has odd behaviors like slapping his hands all the time. Medical attention was sought and the patient "was seen". In February 2009 a urine test was performed which showed high levels of aluminum. The patient was undergoing weekly treatment to chealate aluminum, mercury, lead and nickel since February 2009. On an unspecified date an EEG was performed with abnormal result. An MRI was performed with inconclusive results. The patient's mother believes that any of the above vaccines with preservatives or aluminum may have contributed with his autism. At the time of reporting the patient had not recovered. Upon internal review autism was considered to be another important medical event. Additional information has been requested.
Age: 0.5
Sex: M
Vaccine: RV5
Symptoms: Diarrhoea, Lethargy, Rotavirus infection
Clinical narrative: Information has been received from a registered nurse concerning a 16 month old male with Down's syndrome and cardiac issues, and a history of atrial septal defect and ventricular septal defect (repaired in January 2008) who was orally (via feeding tube) vaccinated with three doses ROTATEQ (1st lot #659682/1733U, 2nd lot #656184/0558U, and 3rd lot #659855/1692U) on 26-FEB-2008, 21-APR-2008 and 01-JUL-2008, respectively. The patient had no known drug allergies. Concomitant therapy included famotidine (MSD) and REGLAN. On 08-MAY-2009 the patient developed rotavirus. He experienced diarrhea and was very lethargic. On 09-MAY-2009, the patient was admitted at a hospital and was still hospitalized at time of reporting. The patient was diagnosed with rotavirus. The patient was recovering at time of reporting. The patient went to hospital for medical attention. Additional information has been requested.
Age: 24.0
Sex: F
Vaccine: HPV4
Symptoms: Alpha 1 foetoprotein normal, Caesarean section, Drug exposure during pregnancy, Labour complication, Oedema
Clinical narrative: Information has been received from a registered nurse for the Pregnancy Registry for GARDASIL concerning a 25 year old female who is a Guillain Barre syndrome carrier with a history of one pregnancy and a live birth and no known medical history or allergies who on 04-DEC-2006 was vaccinated with the first dose of GARDASIL (lot no. 653978-0955F), on 21-SEP-2007 second dose was administered (lot no. 653735/0688F) and on 17-OCT-2007 third dose was administered (lot no. 658282/0929U). Concomitant medication included prenatal vitamins. Subsequently, she became pregnant on 30-AUG-2007 (40 weeks from LMP) delivered a normal, healthy male baby weighing 8.68 pounds, APGAR SCORE 7/9. LMP on 22-NOV-2006, EDD 29-AUG-2007. The nurse also reported that the patient gained excessive weight during pregnancy and experienced edema. On 30-AUG-2007 the patient experienced cesarean section because the patient failed to progress after induction. The patient recovered from cesarean section. Labs and diagnostic test included: on 08-FEB-2007 an ultrasound performed showed unengaged. On 06-Mar-2007 serum alpha-fetoprotein test was negative. Upon internal review failure to progress resulting in c-section was considered an other important medical event. No further information is available.
Age: 24.0
Sex: F
Vaccine: HPV4
Symptoms: Ultrasound scan, Weight increased
Clinical narrative: Information has been received from a registered nurse for the Pregnancy Registry for GARDASIL concerning a 25 year old female who is a Guillain Barre syndrome carrier with a history of one pregnancy and a live birth and no known medical history or allergies who on 04-DEC-2006 was vaccinated with the first dose of GARDASIL (lot no. 653978-0955F), on 21-SEP-2007 second dose was administered (lot no. 653735/0688F) and on 17-OCT-2007 third dose was administered (lot no. 658282/0929U). Concomitant medication included prenatal vitamins. Subsequently, she became pregnant on 30-AUG-2007 (40 weeks from LMP) delivered a normal, healthy male baby weighing 8.68 pounds, APGAR SCORE 7/9. LMP on 22-NOV-2006, EDD 29-AUG-2007. The nurse also reported that the patient gained excessive weight during pregnancy and experienced edema. On 30-AUG-2007 the patient experienced cesarean section because the patient failed to progress after induction. The patient recovered from cesarean section. Labs and diagnostic test included: on 08-FEB-2007 an ultrasound performed showed unengaged. On 06-Mar-2007 serum alpha-fetoprotein test was negative. Upon internal review failure to progress resulting in c-section was considered an other important medical event. No further information is available.
Age: 22.0
Sex: F
Vaccine: HPV4, HPV4
Symptoms: Anaemia of pregnancy, Caesarean section, Complication of pregnancy, Drug exposure during pregnancy, Foetal growth retardation
Clinical narrative: Information has been received from a nurse, for the Pregnancy Registry for GARDASIL concerning a 22 year old patient who on 20-SEP-2006 was vaccinated with a first dose of GARDASIL. The patient had LMP 10-Sep-2006. She received her dose on 20-Sep-2006 and delivered a normal healthy baby boy with no congenital anomalies on 05-Jun-2007. Follow-up information was received from a registered nurse in the office concerning the 22 year old female with renal disease and history of 5 previous pregnancies, 4 live births and 1 spontaneous abortion who on 20-SEP-2006 was vaccinated with GARDASIL (lot #: 653735/0688F). On 20-NOV-2006, the patient was vaccinated with a dose of FLUVIREIN (lot # 7135). Medication used during pregnancy included prenatal vitamin, iron. On unspecified dates the patient had a 24 hour urine, sonos and non stress tests due to history of renal disease. On 05-JUN-2007 the patient delivered a normal, healthy male baby weighing 5 pounds 8 ounces, via repeat C-section at 38 weeks 1 day pregnancy done for "size less than dates" (this was the patient's 3rd c-section). Pregnancy complication was reported as intrauterine growth retardation (IUGR). It was reported that the IUGR was not the reason for the c-section, however they "may have" opted to schedule the c-section at 38 weeks and 1 day, due to the IUGR. The apgar score test was performed with result 9/9. According to the reporter the patient was not hospitalized longer than the "normal" length of stay for a c-section. The patient was diagnosed with post-partum anemia (which did not prolong hospitalization and was not considered life threatening) and has since resolved (date not provided). It was reported they "may have" opted to schedule the c-section at 38 weeks and 1 day, due to the IUGR. Therefore upon internal review, IUGR was considered to be an other important medical event. The patient became pregnant after receiving the second dose of GARDASIL (WAES# 0905USA01417). No further information is available.
Age: 22.0
Sex: F
Vaccine: HPV4, HPV4
Symptoms: Anaemia of pregnancy, Drug exposure during pregnancy, Inappropriate schedule of drug administration, Ultrasound scan, Uterine atony
Clinical narrative: Information has been received from a nurse, for the Pregnancy Registry for GARDASIL concerning a 22 year old patient who on 20-SEP-2006 was vaccinated with a first dose of GARDASIL. The patient had LMP 10-Sep-2006. She received her dose on 20-Sep-2006 and delivered a normal healthy baby boy with no congenital anomalies on 05-Jun-2007. Follow-up information was received from a registered nurse in the office concerning the 22 year old female with renal disease and history of 5 previous pregnancies, 4 live births and 1 spontaneous abortion who on 20-SEP-2006 was vaccinated with GARDASIL (lot #: 653735/0688F). On 20-NOV-2006, the patient was vaccinated with a dose of FLUVIREIN (lot # 7135). Medication used during pregnancy included prenatal vitamin, iron. On unspecified dates the patient had a 24 hour urine, sonos and non stress tests due to history of renal disease. On 05-JUN-2007 the patient delivered a normal, healthy male baby weighing 5 pounds 8 ounces, via repeat C-section at 38 weeks 1 day pregnancy done for "size less than dates" (this was the patient's 3rd c-section). Pregnancy complication was reported as intrauterine growth retardation (IUGR). It was reported that the IUGR was not the reason for the c-section, however they "may have" opted to schedule the c-section at 38 weeks and 1 day, due to the IUGR. The apgar score test was performed with result 9/9. According to the reporter the patient was not hospitalized longer than the "normal" length of stay for a c-section. The patient was diagnosed with post-partum anemia (which did not prolong hospitalization and was not considered life threatening) and has since resolved (date not provided). It was reported they "may have" opted to schedule the c-section at 38 weeks and 1 day, due to the IUGR. Therefore upon internal review, IUGR was considered to be an other important medical event. The patient became pregnant after receiving the second dose of GARDASIL (WAES# 0905USA01417). No further information is available.
Age: 1.2
Sex: F
Vaccine: RV5
Symptoms: Failure to thrive, Rotavirus infection
Clinical narrative: Information has been received from a nurse concerning a 14 month old female who was vaccinated with all three doses of ROTATEQ (dates, route and lot numbers unspecified). The nurse reported that patient weighing 14 pounds was hospitalized for "failure to thrive". While in the hospital the baby got rotavirus. The outcome of the patient is unknown. Additional information has been requested.
Age: 11.0
Sex: M
Vaccine: PPV
Symptoms: Arthralgia, Blood culture positive, Conjunctival oedema, Conjunctivitis, Culture negative
Clinical narrative: Information has been received from authors of a published literature article concerning an 11 year old male patient who was vaccinated with PNEUMOVAX. An 11-year-old male with Hemoglobin sickle C disease (HbSC) disease was admitted to the hospital with 3 day history of fever and left wrist pain. At admission he had significant pain and tenderness at the base of the first left metacarpal bone. He was up to date on his immunizations for Streptococcus pneumoniae (two doses of PNEUMOVAX at 2 and 5 years of age). He had stopped taking penicillin prophylaxis since he was 6 years old and had not received the PREVNAR vaccine. S. pneumoniae was isolated on blood culture and he was treated with Penicillin G. MRI of the left hand showed diffuse edema and mild heterogeneous enhancement of the left first metacarpal bone likely representing osteomyelitis. On the third day of admission he complained of pain in his right eye with excessive tearing and photophobia and he was treated symptomatically. His eye symptoms persisted and an ophthalmology consultation revealed a diagnosis of pneumococcal endogeneous endophthalmitis of the right eye based on his ocular signs and symptoms (2+ flare in AC, chemosis, vitreitis, vitreous opacities, visual acuity R=20/25; L=20/20, ocular culture negative). He was treated with topical antibiotics, mydriatic and intravenous Penicillin G for a total of 6 weeks. He had normal visual acuity in both eyes at discharge and was doing well at 1 year follow up (visual acuity R=20/25 L=20/20). Endogenous endophthalmitis (EE) is a rare, often misdiagnosed disorder characterized by poor visual outcome despite aggressive therapy. Pneumococcal EE has been reported in patients who are immuno-compromised, asplenic or both. The clinical findings of intra-ocular inflammation in the context of S. pneumoniae septicemia in a patient with possible splenic dysfunction made EE the most likely diagnosis in our patient. Blood cultures are the most reliable way of establishing the diagnosis of EE. The initial diagnosis in our case was conjunctivitis, probably of infectious etiology. The increased incidence of proliferative retinopathy associated with HbSC disease may act as a nidus for localization of infection in the eye during episodes of bacteremia and could explain the high incidence of EE in HbSC disease. Systemic antibiotics are the mainstay of therapy in EE, while invasive procedures like vitreal biopsy and intravitreal antibiotics along with vitrectomy are recommended for treatment of traumatic and post-operative endophthalmitis. Our case demonstrates that although rare, EE must be considered in any child with hemoglobinopathy with eye symptoms, especially with a positive blood culture. A high index of suspicion along with early diagnosis and prompt administration of systemic and topical antibiotics may help in complete recovery. Additional information has been requested.
Age: 11.0
Sex: M
Vaccine: PPV
Symptoms: Endophthalmitis, Eye inflammation, Eye pain, Lacrimation increased, Nuclear magnetic resonance imaging abnormal
Clinical narrative: Information has been received from authors of a published literature article concerning an 11 year old male patient who was vaccinated with PNEUMOVAX. An 11-year-old male with Hemoglobin sickle C disease (HbSC) disease was admitted to the hospital with 3 day history of fever and left wrist pain. At admission he had significant pain and tenderness at the base of the first left metacarpal bone. He was up to date on his immunizations for Streptococcus pneumoniae (two doses of PNEUMOVAX at 2 and 5 years of age). He had stopped taking penicillin prophylaxis since he was 6 years old and had not received the PREVNAR vaccine. S. pneumoniae was isolated on blood culture and he was treated with Penicillin G. MRI of the left hand showed diffuse edema and mild heterogeneous enhancement of the left first metacarpal bone likely representing osteomyelitis. On the third day of admission he complained of pain in his right eye with excessive tearing and photophobia and he was treated symptomatically. His eye symptoms persisted and an ophthalmology consultation revealed a diagnosis of pneumococcal endogeneous endophthalmitis of the right eye based on his ocular signs and symptoms (2+ flare in AC, chemosis, vitreitis, vitreous opacities, visual acuity R=20/25; L=20/20, ocular culture negative). He was treated with topical antibiotics, mydriatic and intravenous Penicillin G for a total of 6 weeks. He had normal visual acuity in both eyes at discharge and was doing well at 1 year follow up (visual acuity R=20/25 L=20/20). Endogenous endophthalmitis (EE) is a rare, often misdiagnosed disorder characterized by poor visual outcome despite aggressive therapy. Pneumococcal EE has been reported in patients who are immuno-compromised, asplenic or both. The clinical findings of intra-ocular inflammation in the context of S. pneumoniae septicemia in a patient with possible splenic dysfunction made EE the most likely diagnosis in our patient. Blood cultures are the most reliable way of establishing the diagnosis of EE. The initial diagnosis in our case was conjunctivitis, probably of infectious etiology. The increased incidence of proliferative retinopathy associated with HbSC disease may act as a nidus for localization of infection in the eye during episodes of bacteremia and could explain the high incidence of EE in HbSC disease. Systemic antibiotics are the mainstay of therapy in EE, while invasive procedures like vitreal biopsy and intravitreal antibiotics along with vitrectomy are recommended for treatment of traumatic and post-operative endophthalmitis. Our case demonstrates that although rare, EE must be considered in any child with hemoglobinopathy with eye symptoms, especially with a positive blood culture. A high index of suspicion along with early diagnosis and prompt administration of systemic and topical antibiotics may help in complete recovery. Additional information has been requested.
Age: 11.0
Sex: M
Vaccine: PPV
Symptoms: Oedema, Ophthalmological examination abnormal, Osteomyelitis, Photophobia, Pneumococcal sepsis
Clinical narrative: Information has been received from authors of a published literature article concerning an 11 year old male patient who was vaccinated with PNEUMOVAX. An 11-year-old male with Hemoglobin sickle C disease (HbSC) disease was admitted to the hospital with 3 day history of fever and left wrist pain. At admission he had significant pain and tenderness at the base of the first left metacarpal bone. He was up to date on his immunizations for Streptococcus pneumoniae (two doses of PNEUMOVAX at 2 and 5 years of age). He had stopped taking penicillin prophylaxis since he was 6 years old and had not received the PREVNAR vaccine. S. pneumoniae was isolated on blood culture and he was treated with Penicillin G. MRI of the left hand showed diffuse edema and mild heterogeneous enhancement of the left first metacarpal bone likely representing osteomyelitis. On the third day of admission he complained of pain in his right eye with excessive tearing and photophobia and he was treated symptomatically. His eye symptoms persisted and an ophthalmology consultation revealed a diagnosis of pneumococcal endogeneous endophthalmitis of the right eye based on his ocular signs and symptoms (2+ flare in AC, chemosis, vitreitis, vitreous opacities, visual acuity R=20/25; L=20/20, ocular culture negative). He was treated with topical antibiotics, mydriatic and intravenous Penicillin G for a total of 6 weeks. He had normal visual acuity in both eyes at discharge and was doing well at 1 year follow up (visual acuity R=20/25 L=20/20). Endogenous endophthalmitis (EE) is a rare, often misdiagnosed disorder characterized by poor visual outcome despite aggressive therapy. Pneumococcal EE has been reported in patients who are immuno-compromised, asplenic or both. The clinical findings of intra-ocular inflammation in the context of S. pneumoniae septicemia in a patient with possible splenic dysfunction made EE the most likely diagnosis in our patient. Blood cultures are the most reliable way of establishing the diagnosis of EE. The initial diagnosis in our case was conjunctivitis, probably of infectious etiology. The increased incidence of proliferative retinopathy associated with HbSC disease may act as a nidus for localization of infection in the eye during episodes of bacteremia and could explain the high incidence of EE in HbSC disease. Systemic antibiotics are the mainstay of therapy in EE, while invasive procedures like vitreal biopsy and intravitreal antibiotics along with vitrectomy are recommended for treatment of traumatic and post-operative endophthalmitis. Our case demonstrates that although rare, EE must be considered in any child with hemoglobinopathy with eye symptoms, especially with a positive blood culture. A high index of suspicion along with early diagnosis and prompt administration of systemic and topical antibiotics may help in complete recovery. Additional information has been requested.
Age: 11.0
Sex: M
Vaccine: PPV
Symptoms: Pyrexia, Tenderness, Visual acuity tests abnormal, Visual impairment, Vitreous opacities
Clinical narrative: Information has been received from authors of a published literature article concerning an 11 year old male patient who was vaccinated with PNEUMOVAX. An 11-year-old male with Hemoglobin sickle C disease (HbSC) disease was admitted to the hospital with 3 day history of fever and left wrist pain. At admission he had significant pain and tenderness at the base of the first left metacarpal bone. He was up to date on his immunizations for Streptococcus pneumoniae (two doses of PNEUMOVAX at 2 and 5 years of age). He had stopped taking penicillin prophylaxis since he was 6 years old and had not received the PREVNAR vaccine. S. pneumoniae was isolated on blood culture and he was treated with Penicillin G. MRI of the left hand showed diffuse edema and mild heterogeneous enhancement of the left first metacarpal bone likely representing osteomyelitis. On the third day of admission he complained of pain in his right eye with excessive tearing and photophobia and he was treated symptomatically. His eye symptoms persisted and an ophthalmology consultation revealed a diagnosis of pneumococcal endogeneous endophthalmitis of the right eye based on his ocular signs and symptoms (2+ flare in AC, chemosis, vitreitis, vitreous opacities, visual acuity R=20/25; L=20/20, ocular culture negative). He was treated with topical antibiotics, mydriatic and intravenous Penicillin G for a total of 6 weeks. He had normal visual acuity in both eyes at discharge and was doing well at 1 year follow up (visual acuity R=20/25 L=20/20). Endogenous endophthalmitis (EE) is a rare, often misdiagnosed disorder characterized by poor visual outcome despite aggressive therapy. Pneumococcal EE has been reported in patients who are immuno-compromised, asplenic or both. The clinical findings of intra-ocular inflammation in the context of S. pneumoniae septicemia in a patient with possible splenic dysfunction made EE the most likely diagnosis in our patient. Blood cultures are the most reliable way of establishing the diagnosis of EE. The initial diagnosis in our case was conjunctivitis, probably of infectious etiology. The increased incidence of proliferative retinopathy associated with HbSC disease may act as a nidus for localization of infection in the eye during episodes of bacteremia and could explain the high incidence of EE in HbSC disease. Systemic antibiotics are the mainstay of therapy in EE, while invasive procedures like vitreal biopsy and intravitreal antibiotics along with vitrectomy are recommended for treatment of traumatic and post-operative endophthalmitis. Our case demonstrates that although rare, EE must be considered in any child with hemoglobinopathy with eye symptoms, especially with a positive blood culture. A high index of suspicion along with early diagnosis and prompt administration of systemic and topical antibiotics may help in complete recovery. Additional information has been requested.
Age: 11.0
Sex: M
Vaccine: PPV
Symptoms: Vitritis
Clinical narrative: Information has been received from authors of a published literature article concerning an 11 year old male patient who was vaccinated with PNEUMOVAX. An 11-year-old male with Hemoglobin sickle C disease (HbSC) disease was admitted to the hospital with 3 day history of fever and left wrist pain. At admission he had significant pain and tenderness at the base of the first left metacarpal bone. He was up to date on his immunizations for Streptococcus pneumoniae (two doses of PNEUMOVAX at 2 and 5 years of age). He had stopped taking penicillin prophylaxis since he was 6 years old and had not received the PREVNAR vaccine. S. pneumoniae was isolated on blood culture and he was treated with Penicillin G. MRI of the left hand showed diffuse edema and mild heterogeneous enhancement of the left first metacarpal bone likely representing osteomyelitis. On the third day of admission he complained of pain in his right eye with excessive tearing and photophobia and he was treated symptomatically. His eye symptoms persisted and an ophthalmology consultation revealed a diagnosis of pneumococcal endogeneous endophthalmitis of the right eye based on his ocular signs and symptoms (2+ flare in AC, chemosis, vitreitis, vitreous opacities, visual acuity R=20/25; L=20/20, ocular culture negative). He was treated with topical antibiotics, mydriatic and intravenous Penicillin G for a total of 6 weeks. He had normal visual acuity in both eyes at discharge and was doing well at 1 year follow up (visual acuity R=20/25 L=20/20). Endogenous endophthalmitis (EE) is a rare, often misdiagnosed disorder characterized by poor visual outcome despite aggressive therapy. Pneumococcal EE has been reported in patients who are immuno-compromised, asplenic or both. The clinical findings of intra-ocular inflammation in the context of S. pneumoniae septicemia in a patient with possible splenic dysfunction made EE the most likely diagnosis in our patient. Blood cultures are the most reliable way of establishing the diagnosis of EE. The initial diagnosis in our case was conjunctivitis, probably of infectious etiology. The increased incidence of proliferative retinopathy associated with HbSC disease may act as a nidus for localization of infection in the eye during episodes of bacteremia and could explain the high incidence of EE in HbSC disease. Systemic antibiotics are the mainstay of therapy in EE, while invasive procedures like vitreal biopsy and intravitreal antibiotics along with vitrectomy are recommended for treatment of traumatic and post-operative endophthalmitis. Our case demonstrates that although rare, EE must be considered in any child with hemoglobinopathy with eye symptoms, especially with a positive blood culture. A high index of suspicion along with early diagnosis and prompt administration of systemic and topical antibiotics may help in complete recovery. Additional information has been requested.
Age: 0.6
Sex: M
Vaccine: DTAP, FLU3, HEP, PNC, RV5
Symptoms: Electroencephalogram normal, Guillain-Barre syndrome, Muscular weakness, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal
Clinical narrative: Influenza vaccines rec'd 10/18/07 and 11/20/07. 3 mos later developed Guillain-Barre syndrome/was hospitalizsed for acute lower extr. weakness.  5/19/09 hospital records received DOS 2/13/08 to 2/18/08. FINAL DIAGNOSIS: Acute lower limb weakness, possible Guillain-Barre Syndrome. Post vaccination: Choking episode, weakness and inability to bear weight on lower limbs. Fails to sit up or crawl. Otitis media. Decreased tone and power lower limbs. Biceps/triceps reflexes weak. Absent patellar reflexes. Weak ankle reflexes. Tachypnea, limp 3 doses of intravenous immunoglobulin.  7/7/09 Medical records received DOS 11/20/07 to 3/30/09. Assessment: Acute infective polyneuritis, Guillain-Barre syndrome. Patient presented with absent knee, achilles reflexes and absent superficial reflexes of feet. No rolling, no tactile sensation back. No weight bearing on legs, falls forward when sitting. Keeps legs extended, scissoring. Gradual improvement of neurological findings. Left side of gluteal fold 2 inch erythematous ring surounding pustule.
Age: 44.0
Sex: F
Vaccine: TD
Symptoms: Arthralgia, Pain, Pyrexia
Clinical narrative: Pt called 4/28/09 after sx has resolved. Stated that 12 hr after Td-had arm soreness, faint pain in knees, felt like fever, enlarged lymph node under (L) axilla, and (L) clavicular lymph node enlarged (size of pen). No trouble breathing. Felt like fever and achy all over sx 12 hr after shot -> 72 hr. Pt stated there is nothing to see when asked her to come in.
Age: 18.0
Sex: F
Vaccine: HEPAB, MNQ
Symptoms: Injection site erythema, Injection site swelling
Clinical narrative: 3x3.75 inches erythematous area on left arm, Mildly elevated. Still present 72 hours after vaccination.
Age: 11.0
Sex: M
Vaccine: MNQ, TDAP, VARCEL
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
Clinical narrative: Erythema @ injection site edema pain.
Age: 13.0
Sex: F
Vaccine: HEPA, HPV4, MNQ, TDAP
Symptoms: Eye swelling, Hypoacusis, Lip swelling
Clinical narrative: Pt. at clinic received HPV, MENACTRA, Hep A, Tdap - observed pt. 15 min. after vaccinations. Pt. later reported she couldn't quite hear several hours later at softball practice noted lips swollen (unsure if biting on lip or not). The next morning pt. woke with puffy eyes. Mother reported no respiratory difficulty. Gave BENADRYL with relief.
Age: 6.0
Sex: F
Vaccine: HEPA, VARCEL
Symptoms: Skin lesion
Clinical narrative: Patient received VARIVAX immunization 5/11/09, mom noticed rash on arms, legs and trunk 5/13/09. 8-10 small slightly raised lesions on arm, leg and trunk, no vesicles.
Age: 65.0
Sex: F
Vaccine: PPV, VARZOS
Symptoms: Facial palsy
Clinical narrative: Bell's Palsy
Age: 7.0
Sex: M
Vaccine: PPV
Symptoms: Arthralgia, Injection site erythema, Injection site swelling, Oedema peripheral, Tenderness
Clinical narrative: On day of vaccination, (hours later) redness and swelling developed around injection site.  At ER, patient was given ibuprophen and benadryl.  2 days later, e was seen the office with tenderness and swelling down right arm and into right side of chest.  Arthralgias were also present in the right elbow and shoulder.
Age: 4.0
Sex: F
Vaccine: DTAP, IPV, MMR, VARCEL
Symptoms: Hypersensitivity, Injection site reaction
Clinical narrative: localized alergic reaction to left thigh
Age: 1.08
Sex: F
Vaccine: IPV, MMR, PNC, VARCEL
Symptoms: Rash maculo-papular
Clinical narrative: macular papular rash post auricular nodes
Age: 67.0
Sex: F
Vaccine: PPV
Symptoms: Injection site cellulitis
Clinical narrative: Patient presented to the Emergency Room approximately 27 hours post vaccination with injection site cellulitis.   Symptoms included reddness, heat and edema.  Warm compresses were recommended.
Age: 15.0
Sex: F
Vaccine: MNQ
Symptoms: Dizziness, Headache, Injection site pain
Clinical narrative: Pt was given Menningicoccal vaccine at approx. 9 am. at 930 am she started to feel dizzy and was beginning to get a headache. Her father was called from the school and he brought her home. They called and she seemed comfortable to talk to and denied any  fever,SOB, swelling, hives, disorientation. no complaints at site other than "feeling sore". I spoke with dad and informed him to give benadryl and to let her continue to lie down and drink fluids along with rest. If s/sx persist or worsen she is to go to ED asap! Father agreed.
Age: 17.0
Sex: F
Vaccine: HEPA, VARCEL
Symptoms: Erythema, Oedema peripheral, Skin warm
Clinical narrative: On 5/15/09 patient returned to have a TST read.  PHN observed right arm triceps area reddened, firm and warm to touch in an area 3 1/2 by 2 inches.  Patient states this reaction began on 5/13/09 and has not worsened since then.  She has not taken any antihistamines, done any type of treatment or been seen by her PCP.  Dr. evaluated the right arm site and recommended Benadryl this evening and for patient to be seen by PCP on 5/16/09 if area worsens.  TC to Mom and discussed Dr. instructions and she will get Benadryl and take patient to the Clinic on 5/16/09 if necessary.  TC to mom on 5/18/09 and she states patient's right arm redness and swelling was decreased on 5/16/09 and she did not go to PCP.  Mom states redness and swelling completely gone and only a small bruise remains today.  Benadryl was not given as patient began with stomach flu later on 5/15/09.
Age: 32.0
Sex: M
Vaccine: TDAP
Symptoms: Erythema, Oedema peripheral, Tenderness
Clinical narrative: client complained swollen area about size baseball noted under left arm noticed soreness under arm to chest area . This was first noted on 05162009. client applied heat to area and said it came down to alittle smaller than golf ball on 05172009 and it is about the same today 05172009 there is some reddness noted under arm and firm area that is swollen under arm in lymph node area and soreness still there but has improved some.instructed client to see md and he said if doesn't con't to improve today he will see md.
Age: 11.0
Sex: F
Vaccine: HPV4, MNQ, HPV4, MNQ
Symptoms: Convulsion, Gaze palsy, Malaise
Clinical narrative: Patient tolerated vaccine well, but upon leaving office (within 5 minutes) was "not feeling well" per mom. While in car, continued to complain of not feeling well and then had a seizure(convulsions of arms, legs, eyes rolled back). The episode lasted approximately one minute. Patient still seemed a little "out of it" for a few hours but by 9 pm, was back to normal.  Vaccine was given around 5 pm. Mother had called emergency line, but did not require evaluation in emergency room or office.
Age: 11.0
Sex: F
Vaccine: HPV4, MNQ, HPV4, MNQ
Symptoms: Convulsion
Clinical narrative: Patient tolerated vaccine well, but upon leaving office (within 5 minutes) was "not feeling well" per mom. While in car, continued to complain of not feeling well and then had a seizure(convulsions of arms, legs, eyes rolled back). The episode lasted approximately one minute. Patient still seemed a little "out of it" for a few hours but by 9 pm, was back to normal.  Vaccine was given around 5 pm. Mother had called emergency line, but did not require evaluation in emergency room or office.
Age: 19.0
Sex: M
Vaccine: SMALL, SMALL
Symptoms: Acne, Erythema
Clinical narrative: PT BROKE OUT WITH PIMPLES ON FACE.  SLIGHT REDNESS
Age: 38.0
Sex: F
Vaccine: PPV
Symptoms: Feeling hot, Influenza like illness, Joint range of motion decreased, Pyrexia, Tenderness
Clinical narrative: Pt reports slight fever and flu like symptoms and a base ball size knot that was warm and tender and decreased ROM 2 days post shot. When pt reported the next day the knot had disolved and she was feeling better and full range of motion had returned.
Age: 35.0
Sex: F
Vaccine: MMR
Symptoms: Facial palsy, Headache, Hypoaesthesia oral, Muscle spasms, Muscle twitching
Clinical narrative: Delivered baby on 5/11/09. Got MMR while still in hospital on 5/13/09. 2 hours later c/o numbness of tongue. Later c/o pain and tingling of l neck and back of head. the next morning c/o spasms/twitching of l eyebrow and below l eye & lip followed by numbness and paralysis l side of face and mouth. Now c/o twitching/spasms and weakness of l arm and leg. Going to see a Dr. today.
Age: 35.0
Sex: F
Vaccine: MMR
Symptoms: Muscular weakness, Neck pain, Paraesthesia, Paralysis
Clinical narrative: Delivered baby on 5/11/09. Got MMR while still in hospital on 5/13/09. 2 hours later c/o numbness of tongue. Later c/o pain and tingling of l neck and back of head. the next morning c/o spasms/twitching of l eyebrow and below l eye & lip followed by numbness and paralysis l side of face and mouth. Now c/o twitching/spasms and weakness of l arm and leg. Going to see a Dr. today.
Age: 65.0
Sex: F
Vaccine: PPV
Symptoms: Injection site swelling
Clinical narrative: Pt reported localized swelling at injection site which lasted 48 hrs.
Sex: F
Vaccine: HEP
Symptoms: Induration, Injection site pruritus
Clinical narrative: Developed hard bump in arm that grew in size. She felt itching in the arm of injection that spread over entire body. She had the previous two hepatitis vaccinations with a different manufacturer.
Age: 19.0
Sex: M
Vaccine: HEP, MNQ
Symptoms: Apnoea, Gaze palsy, Heart rate increased, Immediate post-injection reaction, Malaise
Clinical narrative: Client was administered vaccines, before giving vaccine client said he had taken some Benadryl recently for allergies.  After receiving vaccines client sat down in waiting room.  Minutes later client complained of not feeling well, then slumped over in chair and became pale and unresponsive. Client was supported in chair by nurse. Client became rigid, eyes rolled back, and biting tongue.  Another nurse arrived with smelling salts, administered with no response.  Client was moved to the floor with feet elevated.  Client had bouts of apnea lasting 10-15 seconds X5 episodes.  Pulse rapid and weak.  Oxygen administered and 911 called.  Client started to breathe slowly, color returning, still no communication.  Parents were called.  Client continued to improve and able to respond. Complained of nausea and tingling in legs. EMT's arrived and treated client.  Client transported to hospital.  Parents arrived later and were informed of clients condition and referred to ER.
Age: 19.0
Sex: M
Vaccine: HEP, MNQ
Symptoms: Muscle rigidity, Nausea, Pallor, Pulse pressure decreased, Tongue biting
Clinical narrative: Client was administered vaccines, before giving vaccine client said he had taken some Benadryl recently for allergies.  After receiving vaccines client sat down in waiting room.  Minutes later client complained of not feeling well, then slumped over in chair and became pale and unresponsive. Client was supported in chair by nurse. Client became rigid, eyes rolled back, and biting tongue.  Another nurse arrived with smelling salts, administered with no response.  Client was moved to the floor with feet elevated.  Client had bouts of apnea lasting 10-15 seconds X5 episodes.  Pulse rapid and weak.  Oxygen administered and 911 called.  Client started to breathe slowly, color returning, still no communication.  Parents were called.  Client continued to improve and able to respond. Complained of nausea and tingling in legs. EMT's arrived and treated client.  Client transported to hospital.  Parents arrived later and were informed of clients condition and referred to ER.
Age: 19.0
Sex: M
Vaccine: HEP, MNQ
Symptoms: Unresponsive to stimuli
Clinical narrative: Client was administered vaccines, before giving vaccine client said he had taken some Benadryl recently for allergies.  After receiving vaccines client sat down in waiting room.  Minutes later client complained of not feeling well, then slumped over in chair and became pale and unresponsive. Client was supported in chair by nurse. Client became rigid, eyes rolled back, and biting tongue.  Another nurse arrived with smelling salts, administered with no response.  Client was moved to the floor with feet elevated.  Client had bouts of apnea lasting 10-15 seconds X5 episodes.  Pulse rapid and weak.  Oxygen administered and 911 called.  Client started to breathe slowly, color returning, still no communication.  Parents were called.  Client continued to improve and able to respond. Complained of nausea and tingling in legs. EMT's arrived and treated client.  Client transported to hospital.  Parents arrived later and were informed of clients condition and referred to ER.
Age: 2.0
Sex: M
Vaccine: HEPA, HIBV
Symptoms: Electrocardiogram normal, Electroencephalogram normal, Febrile convulsion, Pyrexia
Clinical narrative: Patient was given Vaccines and 48 hours later began having fevers and resultant febrile seizure.  Had an ear infection noted at the appointment when shots were given.  5/21/09 Hospital records received DOS 5/16/09 to 5/18/09. FINAL DIAGNOSIS: Second febrile seizure following immunizations and otitis media. Post vaccination otitis media, febrile seizures, shaking, twitching, turned blue, given CPR, post-ictal state. Irritable, decreased activity, vomited.  6/10/09 ICD-9 codes received-780.31 febrile convulsions (simple)unspecified. 382.9 unspecificed otitis media.
Age: 25.0
Sex: F
Vaccine: HPV4
Symptoms: Arthralgia, Back pain, Computerised tomogram, Dizziness, Dyspnoea
Clinical narrative: extreme fatigue, migraines, nose bleeds, muscle & joint pain, sensitivity to light, mood swings, irritable, brain fog, dizzy spells, trembles, numbness, back pain, pins & needles, memory fog, skin rashes, pancreatitis, stomach ulcers, shortness of breath
Age: 25.0
Sex: F
Vaccine: HPV4
Symptoms: Electroencephalogram, Epistaxis, Fatigue, Feeling abnormal, Gastric ulcer
Clinical narrative: extreme fatigue, migraines, nose bleeds, muscle & joint pain, sensitivity to light, mood swings, irritable, brain fog, dizzy spells, trembles, numbness, back pain, pins & needles, memory fog, skin rashes, pancreatitis, stomach ulcers, shortness of breath
Age: 25.0
Sex: F
Vaccine: HPV4
Symptoms: Gastrointestinal disorder, Hypoaesthesia, Irritability, Memory impairment, Migraine
Clinical narrative: extreme fatigue, migraines, nose bleeds, muscle & joint pain, sensitivity to light, mood swings, irritable, brain fog, dizzy spells, trembles, numbness, back pain, pins & needles, memory fog, skin rashes, pancreatitis, stomach ulcers, shortness of breath