chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 35.0
Sex: U
Vaccine: ANTH, YF
Symptoms: Nuclear magnetic resonance imaging normal, Rash, Rash maculo-papular, Rash pruritic, Red blood cell sedimentation rate normal
Clinical narrative: Description: Diffuse maculopapular rash of both UE/LE and trunk within 48 hours of anthrax #2 and yellow fever vaccines.  Symptom:  Joint Pain, multiple joints Start: 11/04/1997 Comment: bilateral hands, feet, knees.  Symptom:  Rash, pruritic Start:  06/30/1996 Symptom:  Rash, diffuse Start:  06/30/1996
Age: 35.0
Sex: U
Vaccine: ANTH, YF
Symptoms: Rheumatoid factor negative, X-ray limb normal
Clinical narrative: Description: Diffuse maculopapular rash of both UE/LE and trunk within 48 hours of anthrax #2 and yellow fever vaccines.  Symptom:  Joint Pain, multiple joints Start: 11/04/1997 Comment: bilateral hands, feet, knees.  Symptom:  Rash, pruritic Start:  06/30/1996 Symptom:  Rash, diffuse Start:  06/30/1996
Age: 25.0
Sex: F
Vaccine: HEP, MMR, TDAP
Symptoms: Neutrophil count, Rash, White blood cell count decreased
Clinical narrative: Rash- competent w/ past - MMR rash. Decreased WBC count 1.7, ANC700. Resolved within 1wk.
Age: 18.0
Sex: M
Vaccine: FLUX, SMALL, TYP, YF
Symptoms: Asthenia, Bacteraemia, Cold agglutinins positive, Dysphagia, Dysphagia
Clinical narrative: 12/13/86 - received spv, yellow fever, typhoid, and flu vaccines. On that day after the vaccinations, gradually started to feel "exhausted and weak" - had the onset of progressive n/v, inability to swallow, and fever (temp not taken) - also developed rapid onset of swelling to the left upper arm (where the spv was given) along with rash (initially noticed on chest, pt. does not remember if pruritic) - rashes spread to bilat arms (majority on chest) - "looked like mosquito bites" - above sxs worsened. 12/14/86 - went to ER - was initially dx'ed with "cellulitis from the site of immunization" - was admitted (r/o sepsis) for the following 4 wks - positive staph and increased cold agglutinins titer (doubled from 1:32 to 1:512) - above successfully treated with IV antibiotics - dx at clc "bacteremia secondary to staph secondary to possible Inoculation Immunization" - echo "no evidence of vegetation".  6/23/09 Medical records received DOS 12/13/86 to 2/4/05. Assessment: Sepsis with diffused rash temporally associated with receipt of vaccines. Patient presented feeling exhaused and weak. Nausea, vomiting, inability to swallow, fever, swelling of left upper arm (site of smallpox vaccine), rash on chest and arms. Cellulitis from site of immunization. Bacteremia staph secondary to possible innoculation immunization. IV antibiotics. ICD-9 codes: 401.9, 780.7, 782.1, 790.7
Age: 18.0
Sex: M
Vaccine: FLUX, SMALL, TYP, YF
Symptoms: Echocardiogram normal, Fatigue, Injection site cellulitis, Injection site swelling, Laboratory test
Clinical narrative: 12/13/86 - received spv, yellow fever, typhoid, and flu vaccines. On that day after the vaccinations, gradually started to feel "exhausted and weak" - had the onset of progressive n/v, inability to swallow, and fever (temp not taken) - also developed rapid onset of swelling to the left upper arm (where the spv was given) along with rash (initially noticed on chest, pt. does not remember if pruritic) - rashes spread to bilat arms (majority on chest) - "looked like mosquito bites" - above sxs worsened. 12/14/86 - went to ER - was initially dx'ed with "cellulitis from the site of immunization" - was admitted (r/o sepsis) for the following 4 wks - positive staph and increased cold agglutinins titer (doubled from 1:32 to 1:512) - above successfully treated with IV antibiotics - dx at clc "bacteremia secondary to staph secondary to possible Inoculation Immunization" - echo "no evidence of vegetation".  6/23/09 Medical records received DOS 12/13/86 to 2/4/05. Assessment: Sepsis with diffused rash temporally associated with receipt of vaccines. Patient presented feeling exhaused and weak. Nausea, vomiting, inability to swallow, fever, swelling of left upper arm (site of smallpox vaccine), rash on chest and arms. Cellulitis from site of immunization. Bacteremia staph secondary to possible innoculation immunization. IV antibiotics. ICD-9 codes: 401.9, 780.7, 782.1, 790.7
Age: 18.0
Sex: M
Vaccine: FLUX, SMALL, TYP, YF
Symptoms: Nausea, Pyrexia, Rash, Rash, Staphylococcal infection
Clinical narrative: 12/13/86 - received spv, yellow fever, typhoid, and flu vaccines. On that day after the vaccinations, gradually started to feel "exhausted and weak" - had the onset of progressive n/v, inability to swallow, and fever (temp not taken) - also developed rapid onset of swelling to the left upper arm (where the spv was given) along with rash (initially noticed on chest, pt. does not remember if pruritic) - rashes spread to bilat arms (majority on chest) - "looked like mosquito bites" - above sxs worsened. 12/14/86 - went to ER - was initially dx'ed with "cellulitis from the site of immunization" - was admitted (r/o sepsis) for the following 4 wks - positive staph and increased cold agglutinins titer (doubled from 1:32 to 1:512) - above successfully treated with IV antibiotics - dx at clc "bacteremia secondary to staph secondary to possible Inoculation Immunization" - echo "no evidence of vegetation".  6/23/09 Medical records received DOS 12/13/86 to 2/4/05. Assessment: Sepsis with diffused rash temporally associated with receipt of vaccines. Patient presented feeling exhaused and weak. Nausea, vomiting, inability to swallow, fever, swelling of left upper arm (site of smallpox vaccine), rash on chest and arms. Cellulitis from site of immunization. Bacteremia staph secondary to possible innoculation immunization. IV antibiotics. ICD-9 codes: 401.9, 780.7, 782.1, 790.7
Age: 18.0
Sex: M
Vaccine: FLUX, SMALL, TYP, YF
Symptoms: Vaccination complication, Vomiting
Clinical narrative: 12/13/86 - received spv, yellow fever, typhoid, and flu vaccines. On that day after the vaccinations, gradually started to feel "exhausted and weak" - had the onset of progressive n/v, inability to swallow, and fever (temp not taken) - also developed rapid onset of swelling to the left upper arm (where the spv was given) along with rash (initially noticed on chest, pt. does not remember if pruritic) - rashes spread to bilat arms (majority on chest) - "looked like mosquito bites" - above sxs worsened. 12/14/86 - went to ER - was initially dx'ed with "cellulitis from the site of immunization" - was admitted (r/o sepsis) for the following 4 wks - positive staph and increased cold agglutinins titer (doubled from 1:32 to 1:512) - above successfully treated with IV antibiotics - dx at clc "bacteremia secondary to staph secondary to possible Inoculation Immunization" - echo "no evidence of vegetation".  6/23/09 Medical records received DOS 12/13/86 to 2/4/05. Assessment: Sepsis with diffused rash temporally associated with receipt of vaccines. Patient presented feeling exhaused and weak. Nausea, vomiting, inability to swallow, fever, swelling of left upper arm (site of smallpox vaccine), rash on chest and arms. Cellulitis from site of immunization. Bacteremia staph secondary to possible innoculation immunization. IV antibiotics. ICD-9 codes: 401.9, 780.7, 782.1, 790.7
Age: 34.0
Sex: M
Vaccine: TDAP
Symptoms: Abdominal pain upper, Body temperature increased, Diarrhoea, Headache
Clinical narrative: Tdap given on 06-11-09.  Began having an elevated temperature on 06-12-09.  Also c/o headache, stomach ache, + diarrhea.  Highest temperature was 101.9.  Afebrile on 06-15-09, Headache gone.  Still some diarrhea.
Age: 5.0
Sex: M
Vaccine: DTAP
Symptoms: Injection site erythema, Injection site swelling
Clinical narrative: No fever, redness and swelling from injection site to approx. 1 inch of elbow. Client not c/o pain or discomfort.
Age: 12.0
Sex: F
Vaccine: HPV4, MNQ, TDAP, VARCEL
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Pruritus
Clinical narrative: Swelling and red reaction with induration approx. 10 cm in size less than 30 minutes following vaccination. These reactions noted at VARIVAX vaccine site. Applied ice pack and administered BENADRYL (liquid, PO) to patient. Patient stated site felt "itchy";  and stop itching.
Age: 27.0
Sex: F
Vaccine: TDAP
Symptoms: Headache, Nausea, Pain, Pyrexia
Clinical narrative: Received a phone call from patient 6-9-09 stating c/o fever, headaches, generalized body aches and nausea hours after receiving Tdap on 6-8-09.
Age: 63.0
Sex: F
Vaccine: TYP
Symptoms: Lethargy, Pruritus, Rash, Swelling, Urticaria
Clinical narrative: Developed rash on face and upper body.  Over in 3 days.  Terribly itchy, hives, swelling right side eye-chin-collar bone.  lethargic.  Took benadryl on 13th;  next day took prednisone which brought down symptoms.  Today, see that is ending.  According to literature reviewed...had light case of typhoid.  Put warning that patient with gastrointestinal conditions should not take this vaccine.
Age: 0.3
Sex: F
Vaccine: DTAPIPVHIB, PNC, RV5
Symptoms: Diarrhoea, Oedema peripheral, Pyrexia
Clinical narrative: On 6/10/09 grandmother presented to Health Unit and reported that health care professional  went to pediatrician today & was sent to E.R. for "high fever, swelling of both legs and passing clear liquid out of her rectum." On 6/12/09, spoke with mother, mother states "she's fine". Clear liquid from rectum was just diarrhea.
Age: 0.5
Sex: M
Vaccine: DTAPIPVHIB, PNC, RV5
Symptoms: Convulsion
Clinical narrative: Seizure
Age: 1.6
Sex: M
Vaccine: DTAPH, HEPA, IPV
Symptoms: Convulsion, Crying, Electroencephalogram, Musculoskeletal stiffness, Neurological examination
Clinical narrative: Apparent seizure that evening after receiving vaccines in office.  Dad report stiffening & shaking episode < 1 min while in highchair at restaurant.  Then he cried & wanted to be held for a minute.  Sz X 3-4 events prompting visit 5/29/09 Fever up to 101 X 2 days post vaccines.
Age: 1.6
Sex: M
Vaccine: DTAPH, HEPA, IPV
Symptoms: Pyrexia, Tremor
Clinical narrative: Apparent seizure that evening after receiving vaccines in office.  Dad report stiffening & shaking episode < 1 min while in highchair at restaurant.  Then he cried & wanted to be held for a minute.  Sz X 3-4 events prompting visit 5/29/09 Fever up to 101 X 2 days post vaccines.
Age: 4.0
Sex: F
Vaccine: DTAPIPV, MMR, VARCEL
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
Clinical narrative: Received Kinrix on 6/11/09, IM/L arm.  Mom noted redness + swelling on 6/12/09, arm warm to touch in the upper deltoid area;  good ROM.  Mom reported to office on 6/13, None examined by MD;  significantly decreased symptoms by 6/16/09.
Age: 4.0
Sex: M
Vaccine: DTAPIPV
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
Clinical narrative: Received Kinrix on 6/10/09 IM/Larm;  mom noted redness + swelling on 6/11/09.  No impaired ROM, c/o sore to touch; arm red, warm swollen from elbow to shoulder, about 2x nl sg.  examined 6/12, arm still red, swollen warm but significantly less, only complaint was when touched, zero cellulitis.
Age: 53.0
Sex: M
Vaccine: FLU3
Symptoms: Oedema peripheral, Pain, Pain in extremity, Pyrexia
Clinical narrative: Body ache, fever, right hand swelling, arm, leg pain.
Age: 39.0
Sex: M
Vaccine: FLUN3
Symptoms: Anion gap decreased, Back pain, Blood calcium decreased, Blood creatine phosphokinase MB, Blood creatine phosphokinase normal
Clinical narrative: Description: 1/21/05- received primary FLUMIST- no problems. 1/23/05- "felt run down". 1/24/05- c/o n/v, diarrhea, fever (temp not taken), chills and night sweats- was seen by PCM- states no diagnosis given- received quarters x2 days. 1/26/05- above sxs improved- started to notice back pain- "felt like I pulled my muscle in the middle of my back"- woke up at midnight with "severe chest pain (pressure-like, sharp and dull, 9/10)," left arm numbness, worsening back pain, and dyspnea- alleviated by sitting- aggravated by lying down- pain similar to pericarditis he had 2 years ago- no c/o f/c, malaise, fatigue, n/v or diaphoresis. 1/27/05- went to ER- was admitted to medical center- over two days, telemetry was at NSR- given dx of acute pericarditis. 1/28/05- was discharged in stable condition with INDOCIN 25mg 1 tab TID x2 wks- f/u scheduled with clinic in 1 week with his PCM- states still had intermittent cp and dyspnea (3/10) at rest at discharge- other sxs resolved. 2/2/05- pt. seen by his Case Manager- states currently has no cp or dyspnea at rest- however still experiences mild (2/10) cp and dyspnea with excessive talking or with increased physical activities. Pt. has a h/o acute pericarditis 2 years ago- pt. unsure if sxs appeared before or after receiving a flu vaccine- was hospitalized- sxs completely dissipated- no reoccurrence of sxs until recent episode. Discussed case via phone with pt's PCM, algorithm review- f/u cardiology referral recommended. Symptom: Flu-like symptoms< 96 hours Start: 01/23/2005 End: 01/26/2005. Symptom: Chest Pain Start: 01/26/2005 Comment: Initial (9/10, at rest), Present (1/10, with increased activity). Symptom: Dyspnea (shortness of breath) Start: 01/16/2005 Comment: Initial (9/10, at rest), Present (2/10, with increased activity). Symptom: Muscle Pain Start: 01/26/2005 End: 01/28/2005 Comment: Back pain.  6/23/09 Medical records recieved DOS 1/21/05 to 2/22/05. Assessment: Acute pericarditis. Records received support previously submitted information. No additional coding.  ICD-9 Codes: 420.90, 786.0, 786.5, 722.52, 477.0
Age: 39.0
Sex: M
Vaccine: FLUN3
Symptoms: Blood potassium decreased, C-reactive protein increased, Chest X-ray abnormal, Chest pain, Chills
Clinical narrative: Description: 1/21/05- received primary FLUMIST- no problems. 1/23/05- "felt run down". 1/24/05- c/o n/v, diarrhea, fever (temp not taken), chills and night sweats- was seen by PCM- states no diagnosis given- received quarters x2 days. 1/26/05- above sxs improved- started to notice back pain- "felt like I pulled my muscle in the middle of my back"- woke up at midnight with "severe chest pain (pressure-like, sharp and dull, 9/10)," left arm numbness, worsening back pain, and dyspnea- alleviated by sitting- aggravated by lying down- pain similar to pericarditis he had 2 years ago- no c/o f/c, malaise, fatigue, n/v or diaphoresis. 1/27/05- went to ER- was admitted to medical center- over two days, telemetry was at NSR- given dx of acute pericarditis. 1/28/05- was discharged in stable condition with INDOCIN 25mg 1 tab TID x2 wks- f/u scheduled with clinic in 1 week with his PCM- states still had intermittent cp and dyspnea (3/10) at rest at discharge- other sxs resolved. 2/2/05- pt. seen by his Case Manager- states currently has no cp or dyspnea at rest- however still experiences mild (2/10) cp and dyspnea with excessive talking or with increased physical activities. Pt. has a h/o acute pericarditis 2 years ago- pt. unsure if sxs appeared before or after receiving a flu vaccine- was hospitalized- sxs completely dissipated- no reoccurrence of sxs until recent episode. Discussed case via phone with pt's PCM, algorithm review- f/u cardiology referral recommended. Symptom: Flu-like symptoms< 96 hours Start: 01/23/2005 End: 01/26/2005. Symptom: Chest Pain Start: 01/26/2005 Comment: Initial (9/10, at rest), Present (1/10, with increased activity). Symptom: Dyspnea (shortness of breath) Start: 01/16/2005 Comment: Initial (9/10, at rest), Present (2/10, with increased activity). Symptom: Muscle Pain Start: 01/26/2005 End: 01/28/2005 Comment: Back pain.  6/23/09 Medical records recieved DOS 1/21/05 to 2/22/05. Assessment: Acute pericarditis. Records received support previously submitted information. No additional coding.  ICD-9 Codes: 420.90, 786.0, 786.5, 722.52, 477.0
Age: 39.0
Sex: M
Vaccine: FLUN3
Symptoms: Diarrhoea, Differential white blood cell count, Dyspnoea, Echocardiogram normal, Electrocardiogram abnormal
Clinical narrative: Description: 1/21/05- received primary FLUMIST- no problems. 1/23/05- "felt run down". 1/24/05- c/o n/v, diarrhea, fever (temp not taken), chills and night sweats- was seen by PCM- states no diagnosis given- received quarters x2 days. 1/26/05- above sxs improved- started to notice back pain- "felt like I pulled my muscle in the middle of my back"- woke up at midnight with "severe chest pain (pressure-like, sharp and dull, 9/10)," left arm numbness, worsening back pain, and dyspnea- alleviated by sitting- aggravated by lying down- pain similar to pericarditis he had 2 years ago- no c/o f/c, malaise, fatigue, n/v or diaphoresis. 1/27/05- went to ER- was admitted to medical center- over two days, telemetry was at NSR- given dx of acute pericarditis. 1/28/05- was discharged in stable condition with INDOCIN 25mg 1 tab TID x2 wks- f/u scheduled with clinic in 1 week with his PCM- states still had intermittent cp and dyspnea (3/10) at rest at discharge- other sxs resolved. 2/2/05- pt. seen by his Case Manager- states currently has no cp or dyspnea at rest- however still experiences mild (2/10) cp and dyspnea with excessive talking or with increased physical activities. Pt. has a h/o acute pericarditis 2 years ago- pt. unsure if sxs appeared before or after receiving a flu vaccine- was hospitalized- sxs completely dissipated- no reoccurrence of sxs until recent episode. Discussed case via phone with pt's PCM, algorithm review- f/u cardiology referral recommended. Symptom: Flu-like symptoms< 96 hours Start: 01/23/2005 End: 01/26/2005. Symptom: Chest Pain Start: 01/26/2005 Comment: Initial (9/10, at rest), Present (1/10, with increased activity). Symptom: Dyspnea (shortness of breath) Start: 01/16/2005 Comment: Initial (9/10, at rest), Present (2/10, with increased activity). Symptom: Muscle Pain Start: 01/26/2005 End: 01/28/2005 Comment: Back pain.  6/23/09 Medical records recieved DOS 1/21/05 to 2/22/05. Assessment: Acute pericarditis. Records received support previously submitted information. No additional coding.  ICD-9 Codes: 420.90, 786.0, 786.5, 722.52, 477.0
Age: 39.0
Sex: M
Vaccine: FLUN3
Symptoms: Fatigue, Feeling abnormal, Fibrin D dimer normal, Full blood count, Haematocrit decreased
Clinical narrative: Description: 1/21/05- received primary FLUMIST- no problems. 1/23/05- "felt run down". 1/24/05- c/o n/v, diarrhea, fever (temp not taken), chills and night sweats- was seen by PCM- states no diagnosis given- received quarters x2 days. 1/26/05- above sxs improved- started to notice back pain- "felt like I pulled my muscle in the middle of my back"- woke up at midnight with "severe chest pain (pressure-like, sharp and dull, 9/10)," left arm numbness, worsening back pain, and dyspnea- alleviated by sitting- aggravated by lying down- pain similar to pericarditis he had 2 years ago- no c/o f/c, malaise, fatigue, n/v or diaphoresis. 1/27/05- went to ER- was admitted to medical center- over two days, telemetry was at NSR- given dx of acute pericarditis. 1/28/05- was discharged in stable condition with INDOCIN 25mg 1 tab TID x2 wks- f/u scheduled with clinic in 1 week with his PCM- states still had intermittent cp and dyspnea (3/10) at rest at discharge- other sxs resolved. 2/2/05- pt. seen by his Case Manager- states currently has no cp or dyspnea at rest- however still experiences mild (2/10) cp and dyspnea with excessive talking or with increased physical activities. Pt. has a h/o acute pericarditis 2 years ago- pt. unsure if sxs appeared before or after receiving a flu vaccine- was hospitalized- sxs completely dissipated- no reoccurrence of sxs until recent episode. Discussed case via phone with pt's PCM, algorithm review- f/u cardiology referral recommended. Symptom: Flu-like symptoms< 96 hours Start: 01/23/2005 End: 01/26/2005. Symptom: Chest Pain Start: 01/26/2005 Comment: Initial (9/10, at rest), Present (1/10, with increased activity). Symptom: Dyspnea (shortness of breath) Start: 01/16/2005 Comment: Initial (9/10, at rest), Present (2/10, with increased activity). Symptom: Muscle Pain Start: 01/26/2005 End: 01/28/2005 Comment: Back pain.  6/23/09 Medical records recieved DOS 1/21/05 to 2/22/05. Assessment: Acute pericarditis. Records received support previously submitted information. No additional coding.  ICD-9 Codes: 420.90, 786.0, 786.5, 722.52, 477.0
Age: 39.0
Sex: M
Vaccine: FLUN3
Symptoms: Hypoaesthesia, Influenza like illness, Influenza serology negative, Nausea, Night sweats
Clinical narrative: Description: 1/21/05- received primary FLUMIST- no problems. 1/23/05- "felt run down". 1/24/05- c/o n/v, diarrhea, fever (temp not taken), chills and night sweats- was seen by PCM- states no diagnosis given- received quarters x2 days. 1/26/05- above sxs improved- started to notice back pain- "felt like I pulled my muscle in the middle of my back"- woke up at midnight with "severe chest pain (pressure-like, sharp and dull, 9/10)," left arm numbness, worsening back pain, and dyspnea- alleviated by sitting- aggravated by lying down- pain similar to pericarditis he had 2 years ago- no c/o f/c, malaise, fatigue, n/v or diaphoresis. 1/27/05- went to ER- was admitted to medical center- over two days, telemetry was at NSR- given dx of acute pericarditis. 1/28/05- was discharged in stable condition with INDOCIN 25mg 1 tab TID x2 wks- f/u scheduled with clinic in 1 week with his PCM- states still had intermittent cp and dyspnea (3/10) at rest at discharge- other sxs resolved. 2/2/05- pt. seen by his Case Manager- states currently has no cp or dyspnea at rest- however still experiences mild (2/10) cp and dyspnea with excessive talking or with increased physical activities. Pt. has a h/o acute pericarditis 2 years ago- pt. unsure if sxs appeared before or after receiving a flu vaccine- was hospitalized- sxs completely dissipated- no reoccurrence of sxs until recent episode. Discussed case via phone with pt's PCM, algorithm review- f/u cardiology referral recommended. Symptom: Flu-like symptoms< 96 hours Start: 01/23/2005 End: 01/26/2005. Symptom: Chest Pain Start: 01/26/2005 Comment: Initial (9/10, at rest), Present (1/10, with increased activity). Symptom: Dyspnea (shortness of breath) Start: 01/16/2005 Comment: Initial (9/10, at rest), Present (2/10, with increased activity). Symptom: Muscle Pain Start: 01/26/2005 End: 01/28/2005 Comment: Back pain.  6/23/09 Medical records recieved DOS 1/21/05 to 2/22/05. Assessment: Acute pericarditis. Records received support previously submitted information. No additional coding.  ICD-9 Codes: 420.90, 786.0, 786.5, 722.52, 477.0
Age: 39.0
Sex: M
Vaccine: FLUN3
Symptoms: Pericarditis, Pyrexia, Troponin, Vomiting
Clinical narrative: Description: 1/21/05- received primary FLUMIST- no problems. 1/23/05- "felt run down". 1/24/05- c/o n/v, diarrhea, fever (temp not taken), chills and night sweats- was seen by PCM- states no diagnosis given- received quarters x2 days. 1/26/05- above sxs improved- started to notice back pain- "felt like I pulled my muscle in the middle of my back"- woke up at midnight with "severe chest pain (pressure-like, sharp and dull, 9/10)," left arm numbness, worsening back pain, and dyspnea- alleviated by sitting- aggravated by lying down- pain similar to pericarditis he had 2 years ago- no c/o f/c, malaise, fatigue, n/v or diaphoresis. 1/27/05- went to ER- was admitted to medical center- over two days, telemetry was at NSR- given dx of acute pericarditis. 1/28/05- was discharged in stable condition with INDOCIN 25mg 1 tab TID x2 wks- f/u scheduled with clinic in 1 week with his PCM- states still had intermittent cp and dyspnea (3/10) at rest at discharge- other sxs resolved. 2/2/05- pt. seen by his Case Manager- states currently has no cp or dyspnea at rest- however still experiences mild (2/10) cp and dyspnea with excessive talking or with increased physical activities. Pt. has a h/o acute pericarditis 2 years ago- pt. unsure if sxs appeared before or after receiving a flu vaccine- was hospitalized- sxs completely dissipated- no reoccurrence of sxs until recent episode. Discussed case via phone with pt's PCM, algorithm review- f/u cardiology referral recommended. Symptom: Flu-like symptoms< 96 hours Start: 01/23/2005 End: 01/26/2005. Symptom: Chest Pain Start: 01/26/2005 Comment: Initial (9/10, at rest), Present (1/10, with increased activity). Symptom: Dyspnea (shortness of breath) Start: 01/16/2005 Comment: Initial (9/10, at rest), Present (2/10, with increased activity). Symptom: Muscle Pain Start: 01/26/2005 End: 01/28/2005 Comment: Back pain.  6/23/09 Medical records recieved DOS 1/21/05 to 2/22/05. Assessment: Acute pericarditis. Records received support previously submitted information. No additional coding.  ICD-9 Codes: 420.90, 786.0, 786.5, 722.52, 477.0
Age: 19.0
Sex: U
Vaccine: HPV4
Symptoms: Rash
Clinical narrative: Rash, but not around injection site.  Rxd Benadryl 25mg 1-2 a day LORATADINE 10mg 1 a day.
Age: 33.0
Sex: U
Vaccine: ANTH
Symptoms: Fatigue, Injection site erythema, Injection site induration, Injection site pain, Laboratory test
Clinical narrative: Vaccination site erythema, induration, tenderness lasting more than 1 month; worsening after each anthrax vaccination. Right sided axillary adenopathy; no constitutional symptoms. Muscle Pain Start: 9/17/2004 - Fatigue Start: 9/17/2004 - Lymphadenopathy, axillary Start: 10/15/2004 - Right side only
Age: 33.0
Sex: U
Vaccine: ANTH
Symptoms: Lymphadenopathy, Myalgia
Clinical narrative: Vaccination site erythema, induration, tenderness lasting more than 1 month; worsening after each anthrax vaccination. Right sided axillary adenopathy; no constitutional symptoms. Muscle Pain Start: 9/17/2004 - Fatigue Start: 9/17/2004 - Lymphadenopathy, axillary Start: 10/15/2004 - Right side only
Age: 0.2
Sex: M
Vaccine: DTAPIPVHIB, HEP, PNC, RV5
Symptoms: Crying, Screaming
Clinical narrative: Vaccines administered 06/10/09 at about 11am. By 2pm child began to scream uncontrollable until about 7pm. No treatment necessary. Was administered Tylenol with no effect on child's discomfort level. "Persistent crying".
Age: 1.1
Sex: F
Vaccine: DTAP, HEPA, MMR, VARCEL
Symptoms: Rash
Clinical narrative: Patient broke out on forehead, face and neck. Benadryl 12.5mg/ml given (PO).
Age: 45.0
Sex: F
Vaccine: ANTH
Symptoms: Arthralgia, Laboratory test
Clinical narrative: Persistent, reproducible arthralgias after each anthrax vaccination. Currently stationed in Qatar. Joint Pain, multiple joints Start: 5/22/2004 comment: has not gone away.
Age: 28.0
Sex: M
Vaccine: ANTH, HEP, SMALL
Symptoms: Activities of daily living impaired, Arrhythmia, Axillary pain, Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased
Clinical narrative: 08/17/04 - received smallpox vaccine on his left upper arm (3 jabs)- denies any problems. 08/27/04 - onset 0600 while sleeping - bilat chest pain ("dull pressure-like" 5/10) radiating to bilat neck and bilat axillaries (did not radiate down to arms) - constant pain and pressure - denies SOB, palpitations, diaphoresis, or n/v - not pleuritic or positional- Pt. presented himself to ER - pain relieved with GI cocktail - Pt. given dx of "non ST segment elevation MI"-Pt. transferred from ER to ICU 08/28/04 - no cardiac sx's during hospitalization - Pt. discharged from hospital in stable condition. 09/07/04- Pt. placed on temp medical suspension for two months (due to Pt. taking Cardizem). 09/27/04 - states had f/u appt. with Doctor, MD- states all his cardiac meds d/c'ed- no lab/ diagnostic tests ordered by Cardiologist. 10/15/04- patient seen by PCM-"Patient not fit to perform military duties (flight) from 10/15/04 to indefinite pending further notice and AMS" 10/19/04- "Patient deemed to be medically unfit for deployment. 10/26/04- Pt's medical documentation received from MD. 10/28/04- Pt. seen in the clinic by his case manager- states has not had any cp or other cardiac sx's since discharge from the hospital - letter sent to Dr. recommending 6wks cardiac f/u for Pt.- Pt. currently on med hold-scheduled to deploy in near future- Pt. would like to deploy ASAP. 11/01/04 - walk in received a copy of immunization record from Pt-copy of letter written to Doctor given to pt.- states has cardiology appt. in Dec 04 - importance of cardiac f/u reinforced - will reevaluate pt's status after results obtained. 11/02/04- spoke with pt's Case Manager, via phone- above plan of care reviewed. Symptoms: Chest pain start: 08/27/2004. END: 08/27/2004. Symptoms: Chest Heaviness Start 08/27/2004. END: 08/27/2004.  6/23/09 Medical records recieved DOS 8/17/04 11/28/04 Assessment: Probable acute myocarditis temporally associated with the receipt of the smallpox vaccine. Patient presented with bilateral (dull pressure like) chest pain radiating to bilat neck bilat axillaries.   ICD-9 Codes: 272.4 Hyperlipidemia
Age: 28.0
Sex: M
Vaccine: ANTH, HEP, SMALL
Symptoms: Blood electrolytes normal, Catheterisation cardiac abnormal, Chest discomfort, Chest pain, Differential white blood cell count normal
Clinical narrative: 08/17/04 - received smallpox vaccine on his left upper arm (3 jabs)- denies any problems. 08/27/04 - onset 0600 while sleeping - bilat chest pain ("dull pressure-like" 5/10) radiating to bilat neck and bilat axillaries (did not radiate down to arms) - constant pain and pressure - denies SOB, palpitations, diaphoresis, or n/v - not pleuritic or positional- Pt. presented himself to ER - pain relieved with GI cocktail - Pt. given dx of "non ST segment elevation MI"-Pt. transferred from ER to ICU 08/28/04 - no cardiac sx's during hospitalization - Pt. discharged from hospital in stable condition. 09/07/04- Pt. placed on temp medical suspension for two months (due to Pt. taking Cardizem). 09/27/04 - states had f/u appt. with Doctor, MD- states all his cardiac meds d/c'ed- no lab/ diagnostic tests ordered by Cardiologist. 10/15/04- patient seen by PCM-"Patient not fit to perform military duties (flight) from 10/15/04 to indefinite pending further notice and AMS" 10/19/04- "Patient deemed to be medically unfit for deployment. 10/26/04- Pt's medical documentation received from MD. 10/28/04- Pt. seen in the clinic by his case manager- states has not had any cp or other cardiac sx's since discharge from the hospital - letter sent to Dr. recommending 6wks cardiac f/u for Pt.- Pt. currently on med hold-scheduled to deploy in near future- Pt. would like to deploy ASAP. 11/01/04 - walk in received a copy of immunization record from Pt-copy of letter written to Doctor given to pt.- states has cardiology appt. in Dec 04 - importance of cardiac f/u reinforced - will reevaluate pt's status after results obtained. 11/02/04- spoke with pt's Case Manager, via phone- above plan of care reviewed. Symptoms: Chest pain start: 08/27/2004. END: 08/27/2004. Symptoms: Chest Heaviness Start 08/27/2004. END: 08/27/2004.  6/23/09 Medical records recieved DOS 8/17/04 11/28/04 Assessment: Probable acute myocarditis temporally associated with the receipt of the smallpox vaccine. Patient presented with bilateral (dull pressure like) chest pain radiating to bilat neck bilat axillaries.   ICD-9 Codes: 272.4 Hyperlipidemia
Age: 28.0
Sex: M
Vaccine: ANTH, HEP, SMALL
Symptoms: Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Full blood count normal, Heart rate decreased
Clinical narrative: 08/17/04 - received smallpox vaccine on his left upper arm (3 jabs)- denies any problems. 08/27/04 - onset 0600 while sleeping - bilat chest pain ("dull pressure-like" 5/10) radiating to bilat neck and bilat axillaries (did not radiate down to arms) - constant pain and pressure - denies SOB, palpitations, diaphoresis, or n/v - not pleuritic or positional- Pt. presented himself to ER - pain relieved with GI cocktail - Pt. given dx of "non ST segment elevation MI"-Pt. transferred from ER to ICU 08/28/04 - no cardiac sx's during hospitalization - Pt. discharged from hospital in stable condition. 09/07/04- Pt. placed on temp medical suspension for two months (due to Pt. taking Cardizem). 09/27/04 - states had f/u appt. with Doctor, MD- states all his cardiac meds d/c'ed- no lab/ diagnostic tests ordered by Cardiologist. 10/15/04- patient seen by PCM-"Patient not fit to perform military duties (flight) from 10/15/04 to indefinite pending further notice and AMS" 10/19/04- "Patient deemed to be medically unfit for deployment. 10/26/04- Pt's medical documentation received from MD. 10/28/04- Pt. seen in the clinic by his case manager- states has not had any cp or other cardiac sx's since discharge from the hospital - letter sent to Dr. recommending 6wks cardiac f/u for Pt.- Pt. currently on med hold-scheduled to deploy in near future- Pt. would like to deploy ASAP. 11/01/04 - walk in received a copy of immunization record from Pt-copy of letter written to Doctor given to pt.- states has cardiology appt. in Dec 04 - importance of cardiac f/u reinforced - will reevaluate pt's status after results obtained. 11/02/04- spoke with pt's Case Manager, via phone- above plan of care reviewed. Symptoms: Chest pain start: 08/27/2004. END: 08/27/2004. Symptoms: Chest Heaviness Start 08/27/2004. END: 08/27/2004.  6/23/09 Medical records recieved DOS 8/17/04 11/28/04 Assessment: Probable acute myocarditis temporally associated with the receipt of the smallpox vaccine. Patient presented with bilateral (dull pressure like) chest pain radiating to bilat neck bilat axillaries.   ICD-9 Codes: 272.4 Hyperlipidemia
Age: 28.0
Sex: M
Vaccine: ANTH, HEP, SMALL
Symptoms: Intensive care, Myocardial infarction, Myocarditis, Neck pain, Troponin increased
Clinical narrative: 08/17/04 - received smallpox vaccine on his left upper arm (3 jabs)- denies any problems. 08/27/04 - onset 0600 while sleeping - bilat chest pain ("dull pressure-like" 5/10) radiating to bilat neck and bilat axillaries (did not radiate down to arms) - constant pain and pressure - denies SOB, palpitations, diaphoresis, or n/v - not pleuritic or positional- Pt. presented himself to ER - pain relieved with GI cocktail - Pt. given dx of "non ST segment elevation MI"-Pt. transferred from ER to ICU 08/28/04 - no cardiac sx's during hospitalization - Pt. discharged from hospital in stable condition. 09/07/04- Pt. placed on temp medical suspension for two months (due to Pt. taking Cardizem). 09/27/04 - states had f/u appt. with Doctor, MD- states all his cardiac meds d/c'ed- no lab/ diagnostic tests ordered by Cardiologist. 10/15/04- patient seen by PCM-"Patient not fit to perform military duties (flight) from 10/15/04 to indefinite pending further notice and AMS" 10/19/04- "Patient deemed to be medically unfit for deployment. 10/26/04- Pt's medical documentation received from MD. 10/28/04- Pt. seen in the clinic by his case manager- states has not had any cp or other cardiac sx's since discharge from the hospital - letter sent to Dr. recommending 6wks cardiac f/u for Pt.- Pt. currently on med hold-scheduled to deploy in near future- Pt. would like to deploy ASAP. 11/01/04 - walk in received a copy of immunization record from Pt-copy of letter written to Doctor given to pt.- states has cardiology appt. in Dec 04 - importance of cardiac f/u reinforced - will reevaluate pt's status after results obtained. 11/02/04- spoke with pt's Case Manager, via phone- above plan of care reviewed. Symptoms: Chest pain start: 08/27/2004. END: 08/27/2004. Symptoms: Chest Heaviness Start 08/27/2004. END: 08/27/2004.  6/23/09 Medical records recieved DOS 8/17/04 11/28/04 Assessment: Probable acute myocarditis temporally associated with the receipt of the smallpox vaccine. Patient presented with bilateral (dull pressure like) chest pain radiating to bilat neck bilat axillaries.   ICD-9 Codes: 272.4 Hyperlipidemia
Age: 28.0
Sex: M
Vaccine: ANTH, HEP, SMALL
Symptoms: Ultrasound Doppler abnormal
Clinical narrative: 08/17/04 - received smallpox vaccine on his left upper arm (3 jabs)- denies any problems. 08/27/04 - onset 0600 while sleeping - bilat chest pain ("dull pressure-like" 5/10) radiating to bilat neck and bilat axillaries (did not radiate down to arms) - constant pain and pressure - denies SOB, palpitations, diaphoresis, or n/v - not pleuritic or positional- Pt. presented himself to ER - pain relieved with GI cocktail - Pt. given dx of "non ST segment elevation MI"-Pt. transferred from ER to ICU 08/28/04 - no cardiac sx's during hospitalization - Pt. discharged from hospital in stable condition. 09/07/04- Pt. placed on temp medical suspension for two months (due to Pt. taking Cardizem). 09/27/04 - states had f/u appt. with Doctor, MD- states all his cardiac meds d/c'ed- no lab/ diagnostic tests ordered by Cardiologist. 10/15/04- patient seen by PCM-"Patient not fit to perform military duties (flight) from 10/15/04 to indefinite pending further notice and AMS" 10/19/04- "Patient deemed to be medically unfit for deployment. 10/26/04- Pt's medical documentation received from MD. 10/28/04- Pt. seen in the clinic by his case manager- states has not had any cp or other cardiac sx's since discharge from the hospital - letter sent to Dr. recommending 6wks cardiac f/u for Pt.- Pt. currently on med hold-scheduled to deploy in near future- Pt. would like to deploy ASAP. 11/01/04 - walk in received a copy of immunization record from Pt-copy of letter written to Doctor given to pt.- states has cardiology appt. in Dec 04 - importance of cardiac f/u reinforced - will reevaluate pt's status after results obtained. 11/02/04- spoke with pt's Case Manager, via phone- above plan of care reviewed. Symptoms: Chest pain start: 08/27/2004. END: 08/27/2004. Symptoms: Chest Heaviness Start 08/27/2004. END: 08/27/2004.  6/23/09 Medical records recieved DOS 8/17/04 11/28/04 Assessment: Probable acute myocarditis temporally associated with the receipt of the smallpox vaccine. Patient presented with bilateral (dull pressure like) chest pain radiating to bilat neck bilat axillaries.   ICD-9 Codes: 272.4 Hyperlipidemia
Age: 17.0
Sex: F
Vaccine: HEPA, VARCEL
Symptoms: Erythema, Induration, Skin warm
Clinical narrative: Erythematous, non-fluctuant, indurated area. Warm to touch, no exudate or focus of fluctuance or purulence.
Age: 15.0
Sex: F
Vaccine: HEPA, VARCEL
Symptoms: Erythema, Induration, Skin lesion
Clinical narrative: Mildly indurated, mildly erythematous lesion over deltoid
Age: 11.0
Sex: M
Vaccine: MNQ, TDAP
Symptoms: Local reaction
Clinical narrative: Local reaction to vaccine
Age: 4.0
Sex: F
Vaccine: DTAP
Symptoms: Erythema, Oedema peripheral
Clinical narrative: (L) Deltoid - swollen, red AMOXICILLIN RX started w/DTAP.
Age: 11.0
Sex: F
Vaccine: HEPA, MNQ, TDAP, VARCEL
Symptoms: Injection site erythema, Injection site swelling, Pyrexia
Clinical narrative: 7 by 2 cm area of erythema/swelling (L) biceps, 2 by 2 cm area of erythema/swelling (R) bicep low grade fever x 24 hours.
Age: 4.0
Sex: M
Vaccine: DTAP, IPV, MMR, VARCEL
Symptoms: Injection site cellulitis, Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling
Clinical narrative: Erythema, induration, swelling, itching left deltoid! - treated for cellulitis with Keflex.
Age: 9.0
Sex: M
Vaccine: VARCEL
Symptoms: Blister, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
Clinical narrative: 9 cm roughly circular red/warm/itching raised patch surrounding injection site. Few clear vesicles (central ) noted started less than 24 hrs after injection
Age: 38.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Burning sensation, Differential white blood cell count normal, Full blood count normal, Paraesthesia oral, Pruritus
Clinical narrative: 1/13/03 - received anthrax vaccine #1 along with SPV- about a week later, noticed rash on left inner thigh- c/o moderate pruritus- was dx'ed with "poison ivy"- sxs fully resolved after receiving a 'steroid shot'- no other medical complaints. 2/24/02 - received anthrax vaccine #2 (alone)- about a week later, again noticed a similar rash on the same area- same intensity- sxs fully resolved in 3 days after using OTC topical "steroid' cream- no other medical complaints. 3/10/03- received anthrax vaccine #3 (alone)- about a week later, similar rash on left inner thigh and right inner thigh/right popliteal fossa area- again used the topical cream mentioned above- full resolution in one day- no other medical complaints. 8/20/03- anthrax vaccine #4- similar incident noted as with anthrax vaccine #3- no other medical complaints. 2/17/04- anthrax vaccine#5- 6 weeks later, awoken from "burning sensation" in his back- noticed "hives all over my back"- c/o severe pruritus- was given BENADRYL PO for his sxs- urticaria fully resolved after three hours- no other medical complaints. Week after the above incident, pt. started to noticed similar hives appearing every morning in different areas of his body (back, calves, arms, hands; dorsal radial)- lesions appear 'early every morning around five and resolve within 2 to 3 hours" without any interventions- c/o moderate pruritus- also c/o "lip tingling" sensation- incident x2- lasted "only few minutes"- "just half of my lower lip"- resolved without any intervention- no c/o respiratory problems or angioedema. 12/08/04-seen by allergist- was given CLARITIN, ZANTAC; and BENADRYL for his sxs- CBC with diff and ESR all WNL- pt. referred to clinic. Patient seen by his Case Manager- c/o persistent hives appearing every morning- denies any relation to physical stimuli- no meds taken for sxs- denies any sx/sx of systemic problems when rashes appear- h/o 'really bad" asthma as a child- denies any h/o skin problems/conditions- no FH of skin problems/conditions- denies allergy to meds or foods. Hives Start: 2/7/2003 - Occurs every morning since receiving anthrax vaccine #5
Age: 38.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Rash, Red blood cell sedimentation rate normal, Urticaria, Vaccine positive rechallenge
Clinical narrative: 1/13/03 - received anthrax vaccine #1 along with SPV- about a week later, noticed rash on left inner thigh- c/o moderate pruritus- was dx'ed with "poison ivy"- sxs fully resolved after receiving a 'steroid shot'- no other medical complaints. 2/24/02 - received anthrax vaccine #2 (alone)- about a week later, again noticed a similar rash on the same area- same intensity- sxs fully resolved in 3 days after using OTC topical "steroid' cream- no other medical complaints. 3/10/03- received anthrax vaccine #3 (alone)- about a week later, similar rash on left inner thigh and right inner thigh/right popliteal fossa area- again used the topical cream mentioned above- full resolution in one day- no other medical complaints. 8/20/03- anthrax vaccine #4- similar incident noted as with anthrax vaccine #3- no other medical complaints. 2/17/04- anthrax vaccine#5- 6 weeks later, awoken from "burning sensation" in his back- noticed "hives all over my back"- c/o severe pruritus- was given BENADRYL PO for his sxs- urticaria fully resolved after three hours- no other medical complaints. Week after the above incident, pt. started to noticed similar hives appearing every morning in different areas of his body (back, calves, arms, hands; dorsal radial)- lesions appear 'early every morning around five and resolve within 2 to 3 hours" without any interventions- c/o moderate pruritus- also c/o "lip tingling" sensation- incident x2- lasted "only few minutes"- "just half of my lower lip"- resolved without any intervention- no c/o respiratory problems or angioedema. 12/08/04-seen by allergist- was given CLARITIN, ZANTAC; and BENADRYL for his sxs- CBC with diff and ESR all WNL- pt. referred to clinic. Patient seen by his Case Manager- c/o persistent hives appearing every morning- denies any relation to physical stimuli- no meds taken for sxs- denies any sx/sx of systemic problems when rashes appear- h/o 'really bad" asthma as a child- denies any h/o skin problems/conditions- no FH of skin problems/conditions- denies allergy to meds or foods. Hives Start: 2/7/2003 - Occurs every morning since receiving anthrax vaccine #5
Age: 39.0
Sex: M
Vaccine: ANTH
Symptoms: Abdominal pain, Antinuclear antibody negative, Arthralgia, Biopsy muscle, Blood cholesterol increased
Clinical narrative: DOD call received from patient on 11/2/04 No problems with first three ANTHRAX vaccines 10/09/03 - received anthrax vaccine #4 (foreign country)- no problems 11/03 - "early Nov 2003," noticed RLQ abd numbness - which spread to LLQ then to bilat upper quads and to epigastric area - aggravated with sitting-alleviated with walking 2/04 - above sxs worsened - c/o constant stabbing pain around the rib cage area - unable to sit or stand - seen by PCM - was given IBUPROFEN 4/04 - above sxs worsened - noticed "crawling" sensation and pain of bilat flank and lateral abd wall - "it felt like someone was beating me with a pipe on my kidneys" - abd CT (r/o cholecystitis) "normal except for kidney stone" (results not available) - seen by nephrologist - was given dx of renal lithlasis - no treatment given - "will watch it" 4/27/04 - ANTHRAX vaccine #5 5/04 - started noticing "muscle twitches" and spasms - initially localized to right calf - spread to "all over my body" - also c/o right hip pain lyme test positive - subsequent western blot x2 negative - neuro (military) suggests lyme disease despite neg western blot - was placed on Doxy bid x2 mos as recommended by neuro - pt. obtained "second opinion" from infectious disease specialist - was told "unsure" - Infectious disease consult and Westeren Blot not confirmatory for its dx - above sensory sxs resolved after taking doxy - no further treatment after the oral doxy 5/11/04 - thoracic MRI - Unremarkable MRI of the thoracic spine 5/13/04 - lumbar MRI - Mild disc bulge at L4-L5 with a left lateral focal annular tear - There is associated mild bilateral neural foraminal stenosis at this level 6/04 - was started on TRILEPTAL 6/18/04 - brain MRI - MRI of the brain is normal 07/07/04 - MRI right hip - 8/04 - obtained new neurologist (civilian) Repeat brain MRI negative 8/10/04 Nerve conduction and EMG - Normal electrodiagnostic study no ALS or motor neuron dysfunction/disease, no neuropathy, no radlculopathy DX: Benign fasciculation/cramping syndrome 11/4/04 Cervical MRI - Degenerative disc disease at the C5-6 and C6-7 levels 1/05 had sleep study done on 1/10 and muscle biopsy on 1/13 - both results pending at time - states most current dx is "muscle cramp syndrome" States feeling "better than before" however cont to c/o persistent pain and muscle spasms - "but I can and will deal with it" - pt. scheduled to leave out of country on 3/22/05 for 3 years Med record release form sent - no documentation received thus far.