chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 1.3
Sex: M
Vaccine: DTAP, HBHEPB, IPV
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth
Clinical narrative: Red, hot, swollen leg from groin to thigh 24 hrs post vaccine left leg no treatment needed.
Age: 4.0
Sex: M
Vaccine: DTAP, IPV, MMR
Symptoms: Erythema, Oedema
Clinical narrative: Mom c/o with swollen red areas. PHN called Dr's office on 3/6/03 PHN told red area approx 4x6cm PHN told normal reaction by MD.
Age: 44.0
Sex: F
Vaccine: TD
Symptoms: Arthralgia, Myalgia, Pain
Clinical narrative: T/C from pt c/o of muscle and joint pain all over had Td 2-4/03 8:45am. Aching by 4pm same day. No redness on swelling at site. Wonders if a reaction to Td states over 10 yrs since last Td. Was handling a horse when had was jammed against trailer hitch/skin on top of hand broken. Pt cleared wound-no signs of infection today: States she did cal PMD post injury and was referred for Tx. Hx of fibromyalgia and also had lung tumor removed 6/99. Never on chemo or medications, missed work lat night do to feeling ill.
Age: 4.0
Sex: M
Vaccine: DTAP, IPV, MMR, DTAP, IPV, MMR
Symptoms: Discomfort, Gait disturbance, Injection site oedema
Clinical narrative: Received DTaP and IPV L thigh 2/24/03. Mom noted swelling entire L thigh to knee next am. C/O discomfort, limping. Seen in office 2/26/03. L thigh swollen entire anterior thigh, including knee, inner aspect thigh red. Afebrile Rx Keflex 250mg TID x 7 days. Swelling improved 2/27, resolved by 3/3. Similar incident in 6 yr old child 2 days later who received IPV only (same lot #) in thigh.
Age: 4.0
Sex: M
Vaccine: DTAP, IPV, MMR
Symptoms: Injection site erythema, Injection site oedema
Clinical narrative: Received IPV vaccine right thigh afternoon of 2/26/03. Mom noted large amount swelling entire R thigh that evening. Seen in office 2/27/03. Afebrile. 6x10cm irregular area redness, swelling entire thigh, not painful. Placed on Keflex 250mg bid x 7-10 days.
Age: 9.0
Sex: F
Vaccine: UNK
Symptoms: Pyrexia, Rash maculo-papular, Rash vesicular
Clinical narrative: Red macules, papules and vesicles on chest and back in different forms and shapes. fever 100.4.
Age: 0.19
Sex: M
Vaccine: DTAP, HIBV, IPV
Symptoms: Convulsion
Clinical narrative: Tonic/clonic seizure as described by mom lasting several seconds. No fever and no history of fever.
Age: 4.0
Sex: M
Vaccine: DTAP, HEPA, IPV
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
Clinical narrative: The day following vaccination, mom reports patient manifesting redness, swelling, warmth around left arm. Taken to clinic. Mom called health department on 3/3/03 to report this reaction and said patient was doing much better.
Age: 8.0
Sex: M
Vaccine: VARCEL
Symptoms: Erythema, Skin ulcer
Clinical narrative: 03/05/03 Developed red lesions more on trunk and upper arms; less on lower legs. One lesion right buccal mucosa. Few with early vesicles.
Sex: F
Vaccine: MMR, PPV
Symptoms: Infection, Joint swelling, Rash
Clinical narrative: 2 weeks after MMR, developed total body rash and joint swelling in hands and conjunctival injection B.
Age: 1.3
Sex: F
Vaccine: DTAP, HIBV, IPV, MMR, VARCEL
Symptoms: Injection site erythema
Clinical narrative: Redness right anterior thigh.
Age: 0.3
Sex: F
Vaccine: DTAP, HBHEPB, IPV, PNC
Symptoms: Pyrexia
Clinical narrative: Pt recd vaccines yesterday. Has fever today of 102F.
Age: 24.0
Sex: M
Vaccine: HEP, HEPA, PPV, TD
Symptoms: Myalgia, Swelling
Clinical narrative: Sore, swollen right arm.
Age: 5.0
Sex: M
Vaccine: DTAP, IPV, MMR
Symptoms: Erythema, Hypersensitivity, Swelling
Clinical narrative: Localized allergic reaction; redness and swelling of thigh.
Age: 0.25
Sex: M
Vaccine: DTAP, HIBV, IPV, PNC
Symptoms: Agitation, Swelling
Clinical narrative: When asked mom at 2/24/03 visit, mom stated baby cried a lot for 2 days. Baby did not sleep well; no fever. Consolable but not always consolable. Little swelling of legs (both). Normal self except frequent crying for 2 days.
Age: 65.0
Sex: M
Vaccine: PPV
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
Clinical narrative: 6 inch swelling, pain, reddness at site of injection (left deltoid area). Also whole left arm swollen. Pt to ice area use analgesic, call MD if fever.
Age: 2.0
Sex: M
Vaccine: DTAP
Symptoms: Injection site erythema, Injection site oedema
Clinical narrative: Left deltoid with reaction- swollen red
Age: 4.0
Sex: F
Vaccine: DTAP
Symptoms: Injection site erythema, Injection site hypersensitivity, Injection site oedema, Pruritus
Clinical narrative: Left deltoid- itchy red swollen
Sex: M
Vaccine: MMR, VARCEL
Symptoms: Injection site erythema, Injection site rash, Pyrexia
Clinical narrative: 5 Vesicular like lesions at injection site with erythema. Low grade fever. injection site left thigh SQ route.
Age: 5.0
Sex: M
Vaccine: DTAP, IPV, MMR
Symptoms: Erythema, Feeling hot, Rash erythematous
Clinical narrative: Red, raised, hot area 3-4 inch diameter.
Age: 1.0
Sex: M
Vaccine: MMR, VARCEL
Symptoms: Pyrexia, Rash
Clinical narrative: Fever Rash
Age: 56.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Musculoskeletal stiffness, Pain, Tenderness
Clinical narrative: Pt got 2 shots around 11:15am. One for flu vaccine and one for pneumonia. By 2:00 or 3:00pm, pt felt listless and mentally dull. By 06:00pm, pt felt stiff in right arm and shoulder (site of shot). By 7:00pm, pt was in so much pain that she wept. This intense pain continued throughout the night. The next day, the pain in my armpit and rib cage had lessened, but still had intense pain near where she had the shots. Now about 4 days later, pt mental state has improved, but still have tenderness in my arm where she had the 2 shots to the extent that she cannot sleep on that side.
Age: 24.0
Sex: M
Vaccine: TD
Symptoms: Dysphagia, Musculoskeletal stiffness
Clinical narrative: Dysphagia. Neck stiffness. Subsidized burning
Age: 19.0
Sex: F
Vaccine: MEN
Symptoms: Arthralgia, Asthenia, Headache, Injection site erythema, Injection site oedema
Clinical narrative: Wed. pm started with swelling at site of injection. Thurs. am at 08:30 site of injection size of quarter. Red and hot to touch. Fri. am at 09:00, pt had joint pain, body ache, HA, no energy. Sun. 03/01/2003 pt Sx resolved by afternoon and site of injection no longer swollen.
Age: 19.0
Sex: F
Vaccine: MEN
Symptoms: Injection site warmth
Clinical narrative: Wed. pm started with swelling at site of injection. Thurs. am at 08:30 site of injection size of quarter. Red and hot to touch. Fri. am at 09:00, pt had joint pain, body ache, HA, no energy. Sun. 03/01/2003 pt Sx resolved by afternoon and site of injection no longer swollen.
Age: 2.0
Sex: F
Vaccine: DTAP, VARCEL
Symptoms: Oedema peripheral, Vasodilation procedure
Clinical narrative: Child's left leg is swollen, red and hot to touch. No fever.
Sex: F
Vaccine: DTAP, HEP, HIBV, MMR
Symptoms: Cough, Dyspnoea, Lacrimal disorder, Pruritus, Vomiting
Clinical narrative: PT given MMR DTaP HDE Hep B. 1 -2 mins later PT had itchy teary eyes, cough, S.O.B. 4-5 mins given Nebuliza treatment oxapen 1.25 mg. Vomiting x 1 during treatment. Still SP?? Erinephroux 0.1 ml given. 6 mins later PT better. Sent home on prepared medication ITan (?) and Benadryl.
Age: 32.0
Sex: F
Vaccine: MMR, MMR
Symptoms: Injection site reaction, Myalgia, Rash
Clinical narrative: Vax administered 12/30/02. C/o soreness at site on 1/2/03. Developed rash on 1/15/03. Seen and treated by a family MD then referred to dermatologist, who Dx'd as reaction to MMR.
Age: 32.0
Sex: F
Vaccine: MMR, MMR
Symptoms: Fatigue, Feeling hot, Injection site erythema, Injection site mass, Pain
Clinical narrative: Vax administered 12/30/02. C/o soreness at site on 1/2/03. Developed rash on 1/15/03. Seen and treated by a family MD then referred to dermatologist, who Dx'd as reaction to MMR.
Age: 32.0
Sex: F
Vaccine: MMR, MMR
Symptoms: Pruritus, Rash papular
Clinical narrative: Vax administered 12/30/02. C/o soreness at site on 1/2/03. Developed rash on 1/15/03. Seen and treated by a family MD then referred to dermatologist, who Dx'd as reaction to MMR.
Age: 1.9
Sex: F
Vaccine: PNC
Symptoms: Injection site erythema
Clinical narrative: Large area of redness to right thigh.
Age: 0.75
Sex: F
Vaccine: HEP, PNC
Symptoms: Cellulitis, Erythema, Injection site induration
Clinical narrative: PT received Prevnar in right thigh IM on 3/3/03. PT seen at medical office on 3/5/03 with 4.5 x 5 cm redness and 2 x 2.5 cm induration. Dx: Vax reaction w/possible cellulitis was given Tx: Benadryl 1/2 tsp tid Also given Hep B in left thigh.
Age: 4.0
Sex: M
Vaccine: DTAP, IPV, MMR
Symptoms: Oedema peripheral, Vasodilation procedure
Clinical narrative: 3/7/03 Left arm red/swollen. Returned to ASAP if Sx's gets worse. Suggested 1 cc packs use periodically for short periods of time.
Age: 1.25
Sex: F
Vaccine: DTAP, MMR, VARCEL
Symptoms: Drug ineffective, Rash, Rhinitis, Skin ulcer
Clinical narrative: Mother called MD. 3/1/03 Chicken pox looking lesions on back, chest. Increased congestion. 3/3/03 Per grandmother more lesions.
Age: 1.0
Sex: F
Vaccine: HIBV, IPV, MMR, PNC
Symptoms: Agitation, Convulsion, Febrile convulsion, Pyrexia
Clinical narrative: Info has been received from an investigator regarding a 12 mt old female who received Prevnar Hib-Titer, MMRII, Varivax, and IPV, vax's on 6/7/00 as part of a medical group's post-marketing surveillance trial. The next day, the child developed irritability, a fever of 103.2 and experienced a seizure. Unspecified lab results were negative. Febrile seizure is considered medically important. Both the medical monitor and the investigator agreed that these events were not related to vax administration. Follow-up info received on 1/25/02 indicated that the investigator has changed his assessment of the relatedness of febrile seizure (expected per package insert) to possibly related to Prevnar admin. Info regarding this event has been forwarded to manufacturers of the different vaccines administered. On 3/13/02 it was administered that there is a duplication of this report. Report #U200200177 is a duplicate of this report.  This case is closed.  (OMIC)
Age: 25.0
Sex: F
Vaccine: IPV, JEV, TYP
Symptoms: Rash
Clinical narrative: It was reported that a 25 y.o. female PT received an Ipol, a Je-Vax and a Typhim VI vax on 12/5/01. The PT was monitored 30 mins in MD's office post vax's, no reaction observed. On 12/22/01 at approx 9 a.m. the PT developed a red, non raised rash, less than the size of a dime on her back and abdomen. Reportedly the PT recovered from this experience
Age: 0.2
Sex: M
Vaccine: HEP, IPV
Symptoms: Pyrexia, Vomiting
Clinical narrative: From correspondence received from manufacturer received on 1/4/02. It was reported that a 2 mt old male PT received his first injection of Engerix-B on 9/21/01. On 9/28/01, the PT experienced fever and vomiting, was seen in the MD's office and was subsequently admitted to the hospital. The PT was seen in the MD's office on 10/1/01 for follow-up. He subsequently received DTP and Prevnar "w/no problems". On 11/27/01, the PT received his 2nd dose of Engerix-B and an injection of Ipol. Approx 2 days later, the PT experienced "severe" vomiting and was seen by the MD. The PT recovered from this experience.
Age: 4.0
Sex: F
Vaccine: IPV
Symptoms: Abscess drainage, Skin discolouration
Clinical narrative: From phone contact received on 2/20/02 at manufacturer, it was reported that a 4 y.o. female received Ipol on 1/8/02. Discoloration and hard lump at inject site noted by her mother on 2/18/02. Seen by pediatrician 2/20/02. Unresolved.
Age: 0.2
Sex: F
Vaccine: DTAP, HBHEPB, IPV, PNC
Symptoms: Pyrexia
Clinical narrative: From mailed correspondence received at manufacturer on 3/4/02 from a research center, it was reported that a female received an Ipol on 8/21/01. The PT developed a fever on the same day of vax. From add'l correspondence received on 12/9/02, it was reported that the 2-mt-old female PT received first dose of Ipol given SC in the right thigh, Tripedia given IM in the left thigh, Comvax given IM in the right thigh, and Prevnar given IM in the right thigh on 8/21/01. The PT did not receive any other vax's w/4 wks of vax date. The PT was seen by an MD and reportedly recovered from the event. The case is closed.
Age: 5.0
Sex: M
Vaccine: IPV
Symptoms: Injection site erythema, Injection site oedema, Injection site reaction, Pyrexia
Clinical narrative: From mailed correspondence received at manufacturer from a research group on 3/4/02, it was reported that a male PT received Ipol vax on 6/28/01. PT developed fever, redness and swelling at the inject site. These events required unspecified treatment in the ER. PT recovered.
Age: 0.5
Sex: M
Vaccine: IPV
Symptoms: Agitation, Injection site inflammation, Injection site oedema, Injection site pain, Injection site reaction
Clinical narrative: From mailed correspondence received at manufacturer on 3/4/02 from a research group, it was reported that a male received Ipol on 12/17/01. It was reported that PT was "rolling his head side to side and has a goofy look in his eyes". He was cranky and screaming. "The inject site reaction described as hot to touch, swollen and very tender."
Age: 0.5
Sex: M
Vaccine: IPV
Symptoms: Personality disorder, Screaming, Staring
Clinical narrative: From mailed correspondence received at manufacturer on 3/4/02 from a research group, it was reported that a male received Ipol on 12/17/01. It was reported that PT was "rolling his head side to side and has a goofy look in his eyes". He was cranky and screaming. "The inject site reaction described as hot to touch, swollen and very tender."
Age: 4.0
Sex: F
Vaccine: DTAP, HEPA, IPV, MMR, DTAP, HEPA, IPV, MMR
Symptoms: Erythema, Injection site erythema, Injection site oedema, Oedema, Vasodilation procedure
Clinical narrative: From phone contact received at manufacturer on 4/29/02, it was reported that a female PT received Infanrix and Ipol on 4/23/02 in the right thigh. MMR and Hep A were administered in the left thigh at the same time. Later that evening, the child was taken to the hospital ER because of swelling, redness and heat of the entire right thigh. The ER administered steroids and the child was sent home.
Age: 4.0
Sex: F
Vaccine: DTAP, HEPA, IPV, MMR, DTAP, HEPA, IPV, MMR
Symptoms: Oedema peripheral
Clinical narrative: From phone contact received at manufacturer on 4/29/02, it was reported that a female PT received Infanrix and Ipol on 4/23/02 in the right thigh. MMR and Hep A were administered in the left thigh at the same time. Later that evening, the child was taken to the hospital ER because of swelling, redness and heat of the entire right thigh. The ER administered steroids and the child was sent home.
Age: 4.0
Sex: M
Vaccine: DTAP, HEPA, IPV, MMR, DTAP, HEPA, IPV, MMR
Symptoms: Injection site erythema, Injection site oedema
Clinical narrative: From phone correspondence received at manufacturer on 4/29/02, it was reported that a 4 y.o. male received DTaP and Infanrix and Ipol vax's in the right thigh on 4/23/02. MMR and Hep A vax were also given on 4/23/02 in the left thigh. The PT returned and treated w/antibiotics for very red and swollen right thigh. From add'l info received at manufacturer on 12/2/02, it was reported that Ipol was given IM in the right thigh. DTaP, was given IM in the right thigh. MMR was given SC in the left thigh. Hep A was given IM in the left thigh. The PT fully recovered form this. Case is closed.
Age: 4.0
Sex: M
Vaccine: DTAP, HEPA, IPV, MMR, DTAP, HEPA, IPV, MMR
Symptoms: Cellulitis, Erythema, Feeling hot, Injection site reaction, Oedema peripheral
Clinical narrative: From phone correspondence received at manufacturer on 4/29/02, it was reported that a 4 y.o. male received DTaP and Infanrix and Ipol vax's in the right thigh on 4/23/02. MMR and Hep A vax were also given on 4/23/02 in the left thigh. The PT returned and treated w/antibiotics for very red and swollen right thigh. From add'l info received at manufacturer on 12/2/02, it was reported that Ipol was given IM in the right thigh. DTaP, was given IM in the right thigh. MMR was given SC in the left thigh. Hep A was given IM in the left thigh. The PT fully recovered form this. Case is closed.
Age: 4.0
Sex: M
Vaccine: DTAP, HEPA, IPV, MMR, DTAP, HEPA, IPV, MMR
Symptoms: Pain
Clinical narrative: From phone correspondence received at manufacturer on 4/29/02, it was reported that a 4 y.o. male received DTaP and Infanrix and Ipol vax's in the right thigh on 4/23/02. MMR and Hep A vax were also given on 4/23/02 in the left thigh. The PT returned and treated w/antibiotics for very red and swollen right thigh. From add'l info received at manufacturer on 12/2/02, it was reported that Ipol was given IM in the right thigh. DTaP, was given IM in the right thigh. MMR was given SC in the left thigh. Hep A was given IM in the left thigh. The PT fully recovered form this. Case is closed.
Age: 4.0
Sex: M
Vaccine: DTAP, IPV, MMR
Symptoms: Injection site reaction
Clinical narrative: From phone contact received at manufacturer on 5/31/02, it was reported by a health care prof'l that 4 y.o. male received Ipol, Infanrix, and MMR on 5/31/02 in the left thigh. PT developed an enlarged area at inject site. PT seen in ER and treated w/oral Prednisone. PT recovered. The PT had no known drug allergies at the time of vax. Responsible MD and PT info have been updated. No add'l info was provided. This case is closed.
Age: 0.2
Sex: F
Vaccine: IPV
Symptoms: Crying, Pyrexia
Clinical narrative: It was reported that a infant rec'd vaccines on 9/20/99. Pt was crying and developed a low grade fever on day of vaccination.
Age: 0.4
Sex: M
Vaccine: DTAP, HBHEPB, IPV, PNC
Symptoms: Granuloma, Hypersensitivity, Injection site mass, Injection site reaction, Langerhans' cell granulomatosis
Clinical narrative: Info has been received on 6/27/02 from a health care prof'l concerning a 5 mt old male PT who was vax'd with the first dose of Infanrix, Comvax, and IPV on 10/29/01. PT presented w/2-3 lumps in both legs w/in the first few wks after receiving the first set of immunizations. On 6/7/02, PT was also vax'd with Infanrix, Comvax, IPV, and Prevnar. On 1/22/02, PT's mother called the MD's office to report that PT's left leg was infected. PT developed nodules to inject sites. Nodules were drained and the cultures revealed sterile abscess. On 2/5/02, new lumps also presented and recheck showed 4-5 mm area that will scar. PT was referred to a local dermatologist at that time. He was evaluated for nodular areas on 3/27/02 at a local university. It was determined that the lumps were due to an aluminum allergic reaction. At the present, PT is doing some follow-up w/the local university. His last visits were on 5/16/02 and 6/14/02. According to the MD's report received on 6/1/02, PT presented w/a palpable subcutaneous nodule of unknown origin in the middle of his right anterior thigh, which is a typical reactionary nodule that develops after vax's which contain aluminum. The pathology report on the biopsy material obtained from the PT shows an inflammatory granuloma consisting of lymphohistocytic reaction and eosinophils was observed, which is consistent w/a vax reaction.
Age: 5.0
Sex: M
Vaccine: IPV
Symptoms: Injection site pain, Injection site swelling
Clinical narrative: It was reported that after receiving vaccines a pt developed pain and swelling at the injection site within 48 hrs of vaccine being administered.
Age: 1.0
Sex: F
Vaccine: IPV
Symptoms: Injection site oedema, Injection site pain
Clinical narrative: It was reported that a year old female received IPOL on 7/31/02. The pt developed pain and swelling at the injection site within 24 hrs of administration. It was not reported whether the pt recovered from the event.
Age: 0.2
Sex: F
Vaccine: DTAP, IPV, IPV, PNC
Symptoms: Injection site erythema, Injection site swelling, Irritability
Clinical narrative: It was reported that a 2 1/2 yr old rec'd vaccinations. Pt experienced redness and swelling on L leg, and also was irritable on 7/15/02. This reporter has 2 more pt's who experienced similar reactions. From additional correspondence rec'd 12/18/02, no new medically significant info was reported. This case is closed.
Age: 0.3
Sex: F
Vaccine: IPV
Symptoms: Injection site pain, Injection site swelling
Clinical narrative: It was reported that after receiving vaccination the pt developed pain and swelling at the injection site within 48 hrs of administration.
Age: 0.2
Sex: F
Vaccine: IPV
Symptoms: Injection site pain, Injection site swelling
Clinical narrative: It was reported that a pt after receiving vaccination developed pain and swelling at injection site within 48 hrs of vaccine being administered.
Age: 4.0
Sex: F
Vaccine: DTAP, IPV
Symptoms: Injection site induration, Injection site inflammation
Clinical narrative: It was reported that a pt rec'd vaccination and developed inflammation and induration at the injection site. She was evaluated by the physician and treated with motrin and benadryl and compresses.
Age: 4.0
Sex: M
Vaccine: DTAP, IPV, DTAP, IPV
Symptoms: Arthralgia, Injection site hypersensitivity, Pruritus, Somnolence
Clinical narrative: It was reported that a pt describes a red itchy swollen right thigh. The swelling was from the top of the knee to the top of the thigh. In addition, it was reported that he experienced pain in the R knee and increased sleep. Treatment was not provided. The pt had no report of adverse experiences following receipt of prior immunizations. The most recent information rec'd reports the outcome as resolved. The case is closed.
Age: 4.0
Sex: M
Vaccine: DTAP, IPV, DTAP, IPV
Symptoms: Injection site erythema, Injection site oedema, Pruritus
Clinical narrative: It was reported that a pt describes a red itchy swollen right thigh. The swelling was from the top of the knee to the top of the thigh. In addition, it was reported that he experienced pain in the R knee and increased sleep. Treatment was not provided. The pt had no report of adverse experiences following receipt of prior immunizations. The most recent information rec'd reports the outcome as resolved. The case is closed.
Age: 30.0
Sex: M
Vaccine: SMALL
Symptoms: Rash pustular, Urticaria
Clinical narrative: VACCINIA, URTICARIAL WHEALS COALESCING ON TRUNK AND FACE WITHOUT OCULAR INVOLVEMENT.  FEW PUSTULES ON BACK.  NO C/O FEVER, COUGH, OR FLU-LIKE SYMPTOMS.
Age: 33.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Erythema, Feeling hot, Oedema, Pruritus, Rash erythematous
Clinical narrative: Vital signs stable. Pt had large erythematous rash that extended down his post. aspect of right arm, 24 hours after vaccination.  Area was warm to the touch.  Another area of eyrthema was noted on medial aspect of same arm that was also edematous and warm.  Both areas had blanching erythema and was not tender.  Pt reported purrtis.  Pt denied any airway problems.  Pt treated with antihistamines and instructed to follow up in 1 week.
Age: 50.0
Sex: F
Vaccine: SMALL
Symptoms: Headache, Pyrexia, Rash macular, Skin ulcer
Clinical narrative: On March 1, 7 days after accidentally touching her son's smallpox vaccination site pustule, started running high fever (101), and headache.  One day later macular rash in trunk and arms lasting 24 hours.  Fever and headache continued for 4-5 days.  She observed 2 round red lesions on the third day of fever, located in the chest right under the breast (one left and one right) painful initially but then very itchy, 2x2 cm, with what looked a pustule in the middle.  When we actually explored the patient, the lesions where 1x1 cm with a tiny pustule (4mm) in teh middle and had no fever anymore.
Age: 14.0
Sex: F
Vaccine: VARCEL
Symptoms: Pain
Clinical narrative: complained of burning pain from side of face down to elbow on arm where shot recieved.  symptoms noted day after receiving shot
Age: 3.0
Sex: F
Vaccine: VARCEL
Symptoms: Pruritus, Rash vesicular
Clinical narrative: AT SITE OF VARIVAX ADMINISTRATION, CHILD DEVELOPED VESICULAR-LIKE LESIONS ON LEFT THIGH WITH PRURITIS AT SITE.
Age: 38.0
Sex: M
Vaccine: ANTH
Symptoms: Injection site erythema, Injection site oedema
Clinical narrative: Swelling of shot area followed by a reddening of area around shot which progressed down arm.
Age: 26.0
Sex: M
Vaccine: SMALL
Symptoms: Blindness, Haemorrhage, Optic neuritis
Clinical narrative: 26 year old male who presented with progressive right eye vision loss; painless. Had ? hemorrhage. Also had blood in anterior chamber. Was sent for further care. Told had optic neuritis.
Sex: M
Vaccine: SMALL
Symptoms: Blindness
Clinical narrative: Patient presented with 1 day of progressive bilateral painless visual loss. His vision was 20/20 which changed to 20/400. Over the next several days, his vision started to improve.
Age: 25.0
Sex: M
Vaccine: SMALL
Symptoms: Asthenia, Malaise, Rhinitis, Upper respiratory tract infection
Clinical narrative: Weakness over body, sickness.
Age: 23.0
Sex: F
Vaccine: SMALL
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Injection site reaction, Lymphadenitis
Clinical narrative: Redness, swollen, painful, hurts to left arm. Dx: Local peri-vaccination site viral cellulitis with axillary lymphadenitis
Age: 23.0
Sex: F
Vaccine: SMALL
Symptoms: Rhinitis
Clinical narrative: Redness, swollen, painful, hurts to left arm. Dx: Local peri-vaccination site viral cellulitis with axillary lymphadenitis
Age: 18.0
Sex: M
Vaccine: SMALL
Symptoms: Bradycardia, Dizziness, Headache, Joint range of motion decreased, Pyrexia
Clinical narrative: Headache, dizzy, couldn't move left arm, drowsy, fever. Dx: Acute viral syndrome. Volume depletion. Intermittent Bradycardia (with ? PR interval).
Age: 18.0
Sex: M
Vaccine: SMALL
Symptoms: Somnolence, Viral infection
Clinical narrative: Headache, dizzy, couldn't move left arm, drowsy, fever. Dx: Acute viral syndrome. Volume depletion. Intermittent Bradycardia (with ? PR interval).
Age: 30.0
Sex: M
Vaccine: SMALL
Symptoms: Influenza, Mouth ulceration, Rash maculo-papular, Skin ulcer
Clinical narrative: "Flu-like illness", macular/papular lesions on chest, back and upper arms. One lesion on roof of mouth.
Age: 22.0
Sex: M
Vaccine: SMALL
Symptoms: Rash maculo-papular, Rash pruritic, Skin ulcer
Clinical narrative: Scattered macular/papular eruptions - some w/small pustules - over trunk and upper arms. Lesions mildly pruritic. Normal eschar at vax site.
Age: 24.0
Sex: M
Vaccine: SMALL
Symptoms: Erythema, Injection site erythema, Injection site reaction, Rash maculo-papular, Rash pustular
Clinical narrative: Macular/papular eruptions with small pustules over trunk, arm and legs. No fever, lesions not pruritic. Very large 7" x 8" area redness around black scab.
Age: 25.0
Sex: M
Vaccine: SMALL
Symptoms: Arthralgia, Headache, Pyrexia
Clinical narrative: Fever, aching in joints, headache.
Age: 20.0
Sex: M
Vaccine: SMALL
Symptoms: Rash, Rash maculo-papular
Clinical narrative: Rash, maculopapular rash, scalp, chest, back.
Age: 33.0
Sex: M
Vaccine: SMALL
Symptoms: Injection site erythema, Rash, Skin ulcer
Clinical narrative: Pt reports rash on upper back, chest, arms. Multiple <1cm macular erythematous lesions on upper back, chest, arms, no pustules.
Age: 43.0
Sex: M
Vaccine: SMALL
Symptoms: Decreased appetite, Erythema, Headache, Lymphadenopathy, Oedema
Clinical narrative: Pt reports both hands swollen, headache, decreased appetite. ? nares edema/erythema neck and NT adenopathy on R side. DX: general viral syndrome
Age: 43.0
Sex: M
Vaccine: SMALL
Symptoms: Swelling, Viral infection
Clinical narrative: Pt reports both hands swollen, headache, decreased appetite. ? nares edema/erythema neck and NT adenopathy on R side. DX: general viral syndrome
Age: 27.0
Sex: M
Vaccine: SMALL
Symptoms: Rash macular, Skin ulcer
Clinical narrative: Macular papules lesions without pustules over neck, truck, and arms, little on lower extremity. Well dried eschar (scar) @ vaccine site.
Age: 34.0
Sex: M
Vaccine: SMALL
Symptoms: Joint stiffness
Clinical narrative: Pt with progressive appearance of worsening sensation of joint stiffness to all joints of L upper extremity (vaccine in L deltoid) with predominant subjective sensation of stiffness to L hand and wrist joint. Objective exam: wnl. 2/22/03 joint stiffness
Age: 20.0
Sex: U
Vaccine: SMALL
Symptoms: Anorexia, Nausea, Syncope
Clinical narrative: Pt had near syncope episode 24 hrs after vaccination and ? 72 hrs after vaccine. Mild anorexia with ?  and nausea.
Age: 30.0
Sex: M
Vaccine: SMALL
Symptoms: Blister, Post vaccination autoinoculation, Skin ulcer, Vaccination complication
Clinical narrative: The pt reported a 1.5cm scaly lesion n shaft of penis 4 days after receiving vaccine. Multiple vesicles appears herpetic  but cannot rule out autoinoculation. Vaccine rec'd 1/30/03
Age: 23.0
Sex: F
Vaccine: SMALL
Symptoms: Dry skin
Clinical narrative: Pale dry  mark on macula proximal forearm, no pustule, no erythema
Age: 26.0
Sex: M
Vaccine: SMALL
Symptoms: Chest pain, Hyperhidrosis, Lymphoedema, Nausea, Pain
Clinical narrative: Fever, body ache, swollen lymph nodes, nausea, red bumps all over body, cold sweats, chest aching.
Age: 26.0
Sex: M
Vaccine: SMALL
Symptoms: Pyrexia, Rash
Clinical narrative: Fever, body ache, swollen lymph nodes, nausea, red bumps all over body, cold sweats, chest aching.
Age: 23.0
Sex: F
Vaccine: SMALL
Symptoms: Erythema multiforme, Rash macular
Clinical narrative: Pt reports 2 days of lacy macular rash on Both thighs,arms, lower trunk (anterior and posterior) non pruritic. Follow by observation ? erythema multiforme.
Age: 32.0
Sex: M
Vaccine: SMALL
Symptoms: Atrial fibrillation
Clinical narrative: New onset Afib time wise related to SPV. No other risk factor except Marfanoid appearance, and positive family history Marfan's. Treated diltiazem, NSR.
Age: 20.0
Sex: F
Vaccine: SMALL
Symptoms: Subcutaneous nodule, Tenderness
Clinical narrative: 4 days of progressive rt supraclavicular tenderness. LAH about 2 X 3 cm firm tender LN (positive mobile) smallpox vaccine given in rt deltoid region. Negative axillary or other evidence of systemic diagnosis or neoplasia by history of exam. Observation at this time with HSAID.
Age: 19.0
Sex: M
Vaccine: SMALL
Symptoms: Rash macular, Skin ulcer
Clinical narrative: I just noticed a new rash on my chest and on my back which is unusual.  6 macular/papular lesions over lt chest/back. No Pruritus.
Age: 23.0
Sex: M
Vaccine: SMALL
Symptoms: Rash macular
Clinical narrative: Blotches on arm and stomach area.  Macular/Papular rash over chest/back/arms and neck.
Age: 22.0
Sex: M
Vaccine: SMALL
Symptoms: Erythema multiforme, Injection site pustule, Pruritus, Rash papular
Clinical narrative: Multiple erythematous papules and pustules randomly distributed over both upper arms and trunk (ventral and dorsal surfaces); positive associated Pruritus.
Age: 34.0
Sex: M
Vaccine: SMALL
Symptoms: Conjunctivitis, Oedema, Papilloedema
Clinical narrative: Conj infection, edema, temporal aspect, OS. Cornea clear, fundi clear. Positive papilledema X 1 day.  Clear throughout OD.
Age: 23.0
Sex: M
Vaccine: SMALL
Symptoms: Rash macular
Clinical narrative: Macular/Papular rash, non-pruritic, over trunk, back and both upper extremities.
Age: 42.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Bradycardia, Chills, Hypotension
Clinical narrative: Refractory chills and rigors without fever, borderline Hypotension, Bradycardia (heart rate approx 50) over 2 days despite rest and Advil 1-2 every 8 hrs prn.
Age: 51.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Pain, Swelling
Clinical narrative: Supraclavicular pains and swelling X 1 day after dual administration of smallpox and Anthrax vaccines.
Age: 46.0
Sex: M
Vaccine: SMALL
Symptoms: Injection site pain, Lymphadenitis
Clinical narrative: 8 days post vaccination, lymphadenitis and tender axilla noted running from vaccination site.
Age: 59.0
Sex: M
Vaccine: SMALL
Symptoms: Rash pruritic
Clinical narrative: 6 days post vaccination, pt presented to clinic with scattered rash on lower legs. Relates rash is pruritic but not exudative. Pt given Allegra 180mg every day.
Age: 28.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Fatigue, Headache, Injection site pustule, Malaise, Oedema
Clinical narrative: Fatigue, headaches, lymphnodes swollen, pustules on site. Achy, malaise transported by ambulance. MD given oral medication. Loss of 4 days work, released no hospitalization.
Age: 28.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Pain
Clinical narrative: Fatigue, headaches, lymphnodes swollen, pustules on site. Achy, malaise transported by ambulance. MD given oral medication. Loss of 4 days work, released no hospitalization.
Age: 33.0
Sex: M
Vaccine: SMALL
Symptoms: Pruritus, Pyrexia, Rash erythematous, Rash papular
Clinical narrative: 33 y/o male presented to clinic 11 days post vaccination with pruritic papular rash to trunk-discrete erythematous papules approx. 15 chest/approx. 15 back-present x 2 day, also c/o fever x 4 days previous. No treatment.
Age: 37.0
Sex: M
Vaccine: SMALL
Symptoms: Rash
Clinical narrative: Rash to arms treated with Atarax.
Age: 27.0
Sex: F
Vaccine: SMALL
Symptoms: Fatigue, Malaise, Myalgia, Pyrexia
Clinical narrative: Fever 102 degrees, muscle aches, fatigue, malaise.
Age: 30.0
Sex: M
Vaccine: SMALL
Symptoms: Cow pox, Injection site erythema, Injection site pain, Malaise, Pruritus
Clinical narrative: 7d s/p vaccinia innoculation-no complaint, local redness and pain days 8-9 with axillary pain. Systemic symptoms of fever, malaise, myalgia and pruritis beginning day 10 s/p vaccine. Day 12 woke with pustules on scalp, face, back, chest/stomach, and arms. Diagnosed as generalized vaccinia and treated with antihistamines and NSAIDS.
Age: 30.0
Sex: M
Vaccine: SMALL
Symptoms: Pyrexia, Rash pustular
Clinical narrative: 7d s/p vaccinia innoculation-no complaint, local redness and pain days 8-9 with axillary pain. Systemic symptoms of fever, malaise, myalgia and pruritis beginning day 10 s/p vaccine. Day 12 woke with pustules on scalp, face, back, chest/stomach, and arms. Diagnosed as generalized vaccinia and treated with antihistamines and NSAIDS.
Age: 4.0
Sex: M
Vaccine: DTAP
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
Clinical narrative: 24 hrs after injection mother noted red, raised area on Left shoulder.  No fever, no other signs or symptoms.  Left shoulder warm to touch, pink, enduration 4cm round area.  Temp. 97.8F
Age: 29.0
Sex: M
Vaccine: SMALL
Symptoms: Cow pox, Erythema multiforme, Hypersensitivity, Pruritus, Rash erythematous
Clinical narrative: Rash started 3/7/03 on Rt. side of abdomen and chest & then spread to trunk. Rash was described as erythematus and macular with questionable central raised papule, minimal itching. MD states diagnosis = Erythema Multiforme-hypersenitivity rash. Infectious disease doc states "diagnosis = "Disseminated Vaccinia".
Age: 29.0
Sex: M
Vaccine: SMALL
Symptoms: Rash macular
Clinical narrative: Rash started 3/7/03 on Rt. side of abdomen and chest & then spread to trunk. Rash was described as erythematus and macular with questionable central raised papule, minimal itching. MD states diagnosis = Erythema Multiforme-hypersenitivity rash. Infectious disease doc states "diagnosis = "Disseminated Vaccinia".
Age: 51.0
Sex: F
Vaccine: SMALL
Symptoms: Chest pain, Headache, Injection site reaction, Nausea
Clinical narrative: PT c/o chest pain and heaviness with severe headache with nausea. Vaccination site scabbing and WNL. Admitted to area hospital and cardiac w/u neg rx'd motrin ans asprin
Age: 52.0
Sex: M
Vaccine: HEPA
Symptoms: Injection site erythema, Injection site reaction, Pruritus
Clinical narrative: This report described an inject site reaction in a 52 y.o. male who received an injection of Havrix. There was no medical history or concurrent conditions. Concurrent medications included valsartan (Diovan) and a "sleep aid (NOS)". He had no adverse experiences following receipt of prior immunizations. On 2/12/02, the vaccinee received his first injection of Havrix. On 2/16/02, 4 days post vax, he developed an inject site reaction characterized by a blister, itching, and redness. The reporter considered the events to be probably related to Havrix admin.
Age: 7.0
Sex: F
Vaccine: HEPA
Symptoms: Cold sweat, Convulsion, Dizziness, Loss of consciousness, Musculoskeletal stiffness
Clinical narrative: Report A0366456A describes a seizure in a 7 year old female who received hep A vaccine. The vaccine provider submitted this report directly to VAERS (ID 184078). Additionally, this report was received from manufacturer. The medical history included "tubes placed in ears at an earlier age." There were no concomitant medications. On 4/18/02, the vaccinee received her second injection of Havrix. She "felt fine after receiving the dose of the vaccine." The vaccinee left the facility and, while walking to the car, "felt nauseous, lost consciousness, was stiff and tonic, and was clammy." Additionally, she was dizzy. She "was out for 30 to 45 seconds, she was white and she did not remember what happened." She was brought back into the office. She was alert and cooperative when she was brought back into the office. The physician made a diagnosis of seizure. The reporter stated that the seizure was possibly related to Havrix administration. The Havrix immunization series was discontinued. The vaccinee was referred to a neurologist for diagnostic evaluation, the results of which were unavailable to the vaccine provider. Therefore, as of 8/22/02, the outcome of the event was unknown. Seizure is considered medically serious (OMIC).
Age: 7.0
Sex: F
Vaccine: HEPA
Symptoms: Nausea
Clinical narrative: Report A0366456A describes a seizure in a 7 year old female who received hep A vaccine. The vaccine provider submitted this report directly to VAERS (ID 184078). Additionally, this report was received from manufacturer. The medical history included "tubes placed in ears at an earlier age." There were no concomitant medications. On 4/18/02, the vaccinee received her second injection of Havrix. She "felt fine after receiving the dose of the vaccine." The vaccinee left the facility and, while walking to the car, "felt nauseous, lost consciousness, was stiff and tonic, and was clammy." Additionally, she was dizzy. She "was out for 30 to 45 seconds, she was white and she did not remember what happened." She was brought back into the office. She was alert and cooperative when she was brought back into the office. The physician made a diagnosis of seizure. The reporter stated that the seizure was possibly related to Havrix administration. The Havrix immunization series was discontinued. The vaccinee was referred to a neurologist for diagnostic evaluation, the results of which were unavailable to the vaccine provider. Therefore, as of 8/22/02, the outcome of the event was unknown. Seizure is considered medically serious (OMIC).
Age: 40.0
Sex: F
Vaccine: HEPA, TD
Symptoms: Arthralgia, Asthenia, Paraesthesia, Pyrexia, Rash
Clinical narrative: This report describes a serum sickness-like reaction in a 40 y.o. female who received Hep A vax inactivated. Medical history, concurrent conditions, and concurrent medications were not provided. Approx at age 30, the subject experienced fever following receipt of 2nd injection of typhoid immunization. On 5/13/02, the subject received her first injection of Havrix. On that same date, she also received a booster injection of tetanus and diphtheria toxoids absorbed; it has been 10 yrs since the previous injection of tetanus and diphtheria toxoids. 2 days later, on 5/19/02, she developed a rash and the following day on 5/20/02, she experienced arthralgias. The subject was seen by the MD, who stated that the subject's "Sx's reminded [her] of a serum sickness like reaction." Treatment, if given, was not reported. Reportedly, the fever resolved on 5/19/02 and the rash resolved on 5/27/02. The reporting MD also stated that the subject still had occasional arthralgias and numbness in her right hand. Additionally, she also had difficulty w/strength in both hands; however, the Sx's were improving slowly. The reporter considered the events to be related to Havrix and tetanus and diphtheria toxoids admin's.
Age: 40.0
Sex: F
Vaccine: HEPA, TD
Symptoms: Serum sickness
Clinical narrative: This report describes a serum sickness-like reaction in a 40 y.o. female who received Hep A vax inactivated. Medical history, concurrent conditions, and concurrent medications were not provided. Approx at age 30, the subject experienced fever following receipt of 2nd injection of typhoid immunization. On 5/13/02, the subject received her first injection of Havrix. On that same date, she also received a booster injection of tetanus and diphtheria toxoids absorbed; it has been 10 yrs since the previous injection of tetanus and diphtheria toxoids. 2 days later, on 5/19/02, she developed a rash and the following day on 5/20/02, she experienced arthralgias. The subject was seen by the MD, who stated that the subject's "Sx's reminded [her] of a serum sickness like reaction." Treatment, if given, was not reported. Reportedly, the fever resolved on 5/19/02 and the rash resolved on 5/27/02. The reporting MD also stated that the subject still had occasional arthralgias and numbness in her right hand. Additionally, she also had difficulty w/strength in both hands; however, the Sx's were improving slowly. The reporter considered the events to be related to Havrix and tetanus and diphtheria toxoids admin's.
Age: 1.4
Sex: F
Vaccine: HEPA, TYP
Symptoms: Convulsion, Diarrhoea, Pyrexia, Rash, Vomiting
Clinical narrative: On 11/1/02, the subject received her 1st 720 EU injection of Havrix, which is not recommended for immunizing children less than 2 years of age. On the same date, she received an injection of typhoid vaccine (mfr unk). At an unspecified time, post vax, on 11/1/02, she experienced fever, diarrhea and was described by her parents as having had a "febrile seizure". The subject received unspecified treatment at the clinic. The reporting pharmacist stated that the diarrhea was probably related to Havrix administration; the relationship of the possible febrile seizure and fever to Havrix administration was unknown. The subject's parent reported that his child experienced a seizure 2 hours, post vax. He stated that the seizure resolved after "a few minutes". The parent reported that the subject was taken to the local ER and hospitalized. She was discharged on 11/2/02. Reportedly, the subject experienced vomiting, fever and a rash on both legs beginning 11/5/02. The Havrix immunization series was reportedly discontinued.
Age: 65.0
Sex: F
Vaccine: HEP, HEPA, HEP, HEPA
Symptoms: Fatigue, Myalgia
Clinical narrative: This report describes sore arms in a 65 y.o. female who received Hep A vax inactivated. The vaccinee was menopausal. She has had Barrett's esophagus since 99, which she was treated with omeprazole (Prilosec). On 1/18/02, the vaccinee received her 2nd injection of Havrix. On that date, she also received her 3rd dose of Hep B vax recombinant. She received 2 injections of the 10 mcg pediatric formulation, to provide the adult dose of 20 mcg. On 1/20/02, she experienced tiredness, sore arms, and "vague" myalgia. Medical attention at a community medical center was required. The PT stated that she did not have the same side effects w/previous doses. The reporter stated that the events were mild in severity and possibly related to Havrix. As of 2/25/02, the events has resolved.
Age: 65.0
Sex: F
Vaccine: HEP, HEPA, HEP, HEPA
Symptoms: Asthenia, Myalgia
Clinical narrative: This report describes sore arms in a 65 y.o. female who received Hep A vax inactivated. The vaccinee was menopausal. She has had Barrett's esophagus since 99, which she was treated with omeprazole (Prilosec). On 1/18/02, the vaccinee received her 2nd injection of Havrix. On that date, she also received her 3rd dose of Hep B vax recombinant. She received 2 injections of the 10 mcg pediatric formulation, to provide the adult dose of 20 mcg. On 1/20/02, she experienced tiredness, sore arms, and "vague" myalgia. Medical attention at a community medical center was required. The PT stated that she did not have the same side effects w/previous doses. The reporter stated that the events were mild in severity and possibly related to Havrix. As of 2/25/02, the events has resolved.
Age: 51.0
Sex: F
Vaccine: HEP, HEPA, TD, TYP, YF, HEP, HEPA, TD, TYP, YF, HEP, HEPA, TD, TYP, YF
Symptoms: Pharyngitis, Tongue oedema
Clinical narrative: A nurse reported the occurrence of an allergic reaction in a 51 year old female who received hep A vaccine inactivated for prophylaxis. The subject's medical history included allergies to pcn, Motrin, codeine, and sulfa. The subject experienced anaphylaxis following Prempro, vitamin E, vitamin C, folic acid, calcium plus vitamin D, and vitamin B-12. On 5/23/02, the subject received injections of Havrix (720A4), Typhim Vi, tetanus and diphtheria toxoids, YF-Vax, and hep B vaccine. Two hours post-immunization, the subject developed a swollen tongue, "mild" swelling of the throat, and itching. The subject was seen in the local ER, where a physician made a diagnosis of "allergic reaction suspected to vaccines." The subject was treated with steroid NOS and antihistamine NOS. Additional info was received on 12/10/02. The events resolved on 5/28/02. The subject received her second injection of Havrix (720A4) on 11/20/02. She was pre-medicated with two unspecified medications for two days prior to receiving the second injection of Havrix. No adverse event occurred. The reporting nurse considered the allergic reaction to be possibly related to each of the vaccines administered on 5/23/02. On 12/10/02, the nurse stated that the tongue swelling was life-threatening; therefore, this report has been reclassified as serious.
Age: 51.0
Sex: F
Vaccine: HEP, HEPA, TD, TYP, YF, HEP, HEPA, TD, TYP, YF, HEP, HEPA, TD, TYP, YF
Symptoms: Hypersensitivity, Pharyngeal oedema, Pruritus, Tongue oedema
Clinical narrative: A nurse reported the occurrence of an allergic reaction in a 51 year old female who received hep A vaccine inactivated for prophylaxis. The subject's medical history included allergies to pcn, Motrin, codeine, and sulfa. The subject experienced anaphylaxis following Prempro, vitamin E, vitamin C, folic acid, calcium plus vitamin D, and vitamin B-12. On 5/23/02, the subject received injections of Havrix (720A4), Typhim Vi, tetanus and diphtheria toxoids, YF-Vax, and hep B vaccine. Two hours post-immunization, the subject developed a swollen tongue, "mild" swelling of the throat, and itching. The subject was seen in the local ER, where a physician made a diagnosis of "allergic reaction suspected to vaccines." The subject was treated with steroid NOS and antihistamine NOS. Additional info was received on 12/10/02. The events resolved on 5/28/02. The subject received her second injection of Havrix (720A4) on 11/20/02. She was pre-medicated with two unspecified medications for two days prior to receiving the second injection of Havrix. No adverse event occurred. The reporting nurse considered the allergic reaction to be possibly related to each of the vaccines administered on 5/23/02. On 12/10/02, the nurse stated that the tongue swelling was life-threatening; therefore, this report has been reclassified as serious.