chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 37.0
Sex: M
Vaccine: FLU3
Symptoms: Cough, Diarrhoea, Dizziness, Eye pruritus, Lacrimation increased
Clinical narrative: This service member was consulted to the Healthcare Center in mid-November for evaluation of a self-reported "allergic reaction to flu vaccine" in 1996. Due to operational constraints he could not be seen until mid-December. The day prior to his scheduled appointment, he contacted the Healthcare Center to provide some background information and to ask our opinion about his recurring URI-like symptoms, similar to past influenza vaccine reactions, since he had chosen to receive his IM influenza vaccine on 12/8/2010 aboard ship prior to evaluation by the Healthcare Center. He advised within a few moments following this vaccination he experienced dizziness described as if woozy and sensation of his head spinning, but with normal vision. This woozy sensation lasted for 4 hours before resolving on its own. He also complained of nausea-vomiting 1 hour post vaccination with diarrhea later that day. Nausea, vomiting & diarrhea lasted about 2 days with >6 episodes diarrhea/day x 2 days and vomiting x 4 over 1 day. He advised onset of cold like symptoms of congestion, sneezing, runny nose, watery itchy eyes within a day post vaccination that persists as of 12/16/2010. He was self treating with NYQUIL. These symptoms were similar to symptoms experienced with his 1996 IM flu vaccine. He advised that within a few minutes post vaccination he felt dizzy with several episodes of nausea, vomiting, diarrhea, coughing, nasal congestion that lasted for 5 days. He recalls his family (2 children) had also received the flu vaccine and they too had similar symptoms. Although he denies receiving any other influenza vaccinations between 1996 and the present, a review of immunization records documents influenza vaccinations on 11/29/01, 12/12/01, 11/1/02, and a med reactive exemption being given on 11/8/05. However, this service member states he does not remember receiving these shots.
Age: 37.0
Sex: M
Vaccine: FLU3
Symptoms: Nasal congestion, Nasopharyngitis, Nausea, Respiratory tract congestion, Rhinorrhoea
Clinical narrative: This service member was consulted to the Healthcare Center in mid-November for evaluation of a self-reported "allergic reaction to flu vaccine" in 1996. Due to operational constraints he could not be seen until mid-December. The day prior to his scheduled appointment, he contacted the Healthcare Center to provide some background information and to ask our opinion about his recurring URI-like symptoms, similar to past influenza vaccine reactions, since he had chosen to receive his IM influenza vaccine on 12/8/2010 aboard ship prior to evaluation by the Healthcare Center. He advised within a few moments following this vaccination he experienced dizziness described as if woozy and sensation of his head spinning, but with normal vision. This woozy sensation lasted for 4 hours before resolving on its own. He also complained of nausea-vomiting 1 hour post vaccination with diarrhea later that day. Nausea, vomiting & diarrhea lasted about 2 days with >6 episodes diarrhea/day x 2 days and vomiting x 4 over 1 day. He advised onset of cold like symptoms of congestion, sneezing, runny nose, watery itchy eyes within a day post vaccination that persists as of 12/16/2010. He was self treating with NYQUIL. These symptoms were similar to symptoms experienced with his 1996 IM flu vaccine. He advised that within a few minutes post vaccination he felt dizzy with several episodes of nausea, vomiting, diarrhea, coughing, nasal congestion that lasted for 5 days. He recalls his family (2 children) had also received the flu vaccine and they too had similar symptoms. Although he denies receiving any other influenza vaccinations between 1996 and the present, a review of immunization records documents influenza vaccinations on 11/29/01, 12/12/01, 11/1/02, and a med reactive exemption being given on 11/8/05. However, this service member states he does not remember receiving these shots.
Age: 37.0
Sex: M
Vaccine: FLU3
Symptoms: Sneezing, Vaccine positive rechallenge, Vertigo, Vomiting
Clinical narrative: This service member was consulted to the Healthcare Center in mid-November for evaluation of a self-reported "allergic reaction to flu vaccine" in 1996. Due to operational constraints he could not be seen until mid-December. The day prior to his scheduled appointment, he contacted the Healthcare Center to provide some background information and to ask our opinion about his recurring URI-like symptoms, similar to past influenza vaccine reactions, since he had chosen to receive his IM influenza vaccine on 12/8/2010 aboard ship prior to evaluation by the Healthcare Center. He advised within a few moments following this vaccination he experienced dizziness described as if woozy and sensation of his head spinning, but with normal vision. This woozy sensation lasted for 4 hours before resolving on its own. He also complained of nausea-vomiting 1 hour post vaccination with diarrhea later that day. Nausea, vomiting & diarrhea lasted about 2 days with >6 episodes diarrhea/day x 2 days and vomiting x 4 over 1 day. He advised onset of cold like symptoms of congestion, sneezing, runny nose, watery itchy eyes within a day post vaccination that persists as of 12/16/2010. He was self treating with NYQUIL. These symptoms were similar to symptoms experienced with his 1996 IM flu vaccine. He advised that within a few minutes post vaccination he felt dizzy with several episodes of nausea, vomiting, diarrhea, coughing, nasal congestion that lasted for 5 days. He recalls his family (2 children) had also received the flu vaccine and they too had similar symptoms. Although he denies receiving any other influenza vaccinations between 1996 and the present, a review of immunization records documents influenza vaccinations on 11/29/01, 12/12/01, 11/1/02, and a med reactive exemption being given on 11/8/05. However, this service member states he does not remember receiving these shots.
Age: 21.0
Sex: F
Vaccine: SMALL, ANTH, HEPA, SMALL
Symptoms: Chest pain, Echocardiogram, Electrocardiogram, Laboratory test
Clinical narrative: This study case was received from the investigator in a trial on 16 March 2011. A 21 year-old female subject with no significant medical history was found to have non-specific myocarditis 4 days after she had received an injection of ACAM2000 (lot number, route and site of administration not reported), ANTHRAX 1 (manufacturer, lot number, route and site of administration not reported) and Hep A (Adult) (manufacturer, lot number, route and site of administration not reported) on 28 July 2010. Relevant laboratory data included: a normal Troponin I, an abnormal ECG and a normal Echocardiogram. Treatments were not reported. Additional information will be requested from the investigator. The subject's outcome was not reported. Note: There is no reporter causality assessment as this is a safety surveillance (data mining, non-interventional) study. Documents held by sender: none.
Age: 21.0
Sex: F
Vaccine: SMALL, ANTH, HEPA, SMALL
Symptoms: Echocardiogram normal, Electrocardiogram abnormal, Myocarditis, Troponin I
Clinical narrative: This study case was received from the investigator in a trial on 16 March 2011. A 21 year-old female subject with no significant medical history was found to have non-specific myocarditis 4 days after she had received an injection of ACAM2000 (lot number, route and site of administration not reported), ANTHRAX 1 (manufacturer, lot number, route and site of administration not reported) and Hep A (Adult) (manufacturer, lot number, route and site of administration not reported) on 28 July 2010. Relevant laboratory data included: a normal Troponin I, an abnormal ECG and a normal Echocardiogram. Treatments were not reported. Additional information will be requested from the investigator. The subject's outcome was not reported. Note: There is no reporter causality assessment as this is a safety surveillance (data mining, non-interventional) study. Documents held by sender: none.
Age: 11.0
Sex: F
Vaccine: HEPA, HPV4, MNQ, TDAP, HEPA, HPV4, TDAP, HEPAB, HPV4, MNQ, TDAP
Symptoms: Diplegia, Inflammation, Muscular weakness, Myelitis transverse, Nuclear magnetic resonance imaging spinal cord abnormal
Clinical narrative: This report was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. An 11 year old female with no pertinent medical history and no previous illness who on 13-OCT-2010 was intramuscularly vaccinated with the first dose of GARDASIL (lot# 666598/0786Z, dose not reported). Concomitant therapy included intramuscular the first dose of MENACTRA (lot# U3443BA, dose not reported), intramuscular the second dose of TWINRIX (lot# AHAVB446AA, dose not reported) and intramuscular the first dose of ADACEL (lot# C3438AA, dose not reported). On 15-OCT-2010, the patient had an onset of lower extremity weakness progressing to complete paralysis of both legs within one week of GARDASIL. Spine MRI showed inflammation at T8-9 level of spinal cord consistent with transverse myelitis. The patient was diagnosed with myelitis transverse and treated with steroids. At the time of report, the outcomes were unknown. It was reported that an ER visit was required. The listing indicated that one or more of the events required hospitalization and extended hospital stay, was considered to be permanent disabling, was considered to be immediately life-threatening. No further information is available. A standard lot check investigation has been finalized. All in-process quality checks for the lot number in question were satisfactory. In addition, an expanded lot check investigation was performed. The testing performed on the batch prior to release met all release specifications. The lot met the requirements of the Center for Biologics Evaluation and Research and was released. The original reporting source was not provided. The VAERS ID# is 414893.
Age: 11.0
Sex: F
Vaccine: HEPA, HPV4, MNQ, TDAP, HEPA, HPV4, TDAP, HEPAB, HPV4, MNQ, TDAP
Symptoms: Dysstasia, Fall, Hypoaesthesia, Paraesthesia
Clinical narrative: This report was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. An 11 year old female with no pertinent medical history and no previous illness who on 13-OCT-2010 was intramuscularly vaccinated with the first dose of GARDASIL (lot# 666598/0786Z, dose not reported). Concomitant therapy included intramuscular the first dose of MENACTRA (lot# U3443BA, dose not reported), intramuscular the second dose of TWINRIX (lot# AHAVB446AA, dose not reported) and intramuscular the first dose of ADACEL (lot# C3438AA, dose not reported). On 15-OCT-2010, the patient had an onset of lower extremity weakness progressing to complete paralysis of both legs within one week of GARDASIL. Spine MRI showed inflammation at T8-9 level of spinal cord consistent with transverse myelitis. The patient was diagnosed with myelitis transverse and treated with steroids. At the time of report, the outcomes were unknown. It was reported that an ER visit was required. The listing indicated that one or more of the events required hospitalization and extended hospital stay, was considered to be permanent disabling, was considered to be immediately life-threatening. No further information is available. A standard lot check investigation has been finalized. All in-process quality checks for the lot number in question were satisfactory. In addition, an expanded lot check investigation was performed. The testing performed on the batch prior to release met all release specifications. The lot met the requirements of the Center for Biologics Evaluation and Research and was released. The original reporting source was not provided. The VAERS ID# is 414893.
Age: 1.18
Sex: F
Vaccine: DTAP, HEPA, HIBV, MMRV, PNC13
Symptoms: Pyrexia, Rash, Varicella
Clinical narrative: Fever on 3/16/11, Rash on 3/17/11. Brought to health dept by parent to ck. rash. Had varicella rash on torso, less rash on face & extremities. No fever (98.3) at time of visit.
Age: 1.0
Sex: F
Vaccine: DTAP, HEPA, HIBV, MMR, PNC13, VARCEL
Symptoms: Unevaluable event
Clinical narrative: None stated.
Age: 0.17
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV5, DTAPHEPBIP, HIBV, PNC, RV5
Symptoms: Rash, Rash maculo-papular
Clinical narrative: Pt received 2 mo immunizations on March 15, 2011, then developed maculopapular rash - trunk/arms/legs approx. 24 hours later.
Age: 0.17
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV5, DTAPHEPBIP, HIBV, PNC, RV5
Symptoms: Rash, Urticaria
Clinical narrative: Pt received 2 mo immunizations on March 15, 2011, then developed maculopapular rash - trunk/arms/legs approx. 24 hours later.
Age: 36.0
Sex: F
Vaccine: YF
Symptoms: Cellulitis, Erythema, Pruritus, Swelling
Clinical narrative: Pt experienced redness, swelling, and itching the day after receiving the yellow fever vaccine. The following day the redness started moving down to her elbow. On the third day she was seen at clinic and was diagnosed with cellulitis and was treated with KEFLEX 500mg.
Sex: F
Vaccine: HPV4
Symptoms: Unevaluable event
Clinical narrative: Information has been received from a website concerning thousands of other young girls who on unspecified dates were vaccinated with a dose of GARDASIL (lot # not reported). The girls have experienced "life-destroying side effects" or death following their HPV vaccines. Life-destroying side effects were considered to be immediately life-threatening. This is one of two reports from the same source. No further information is available.
Age: 14.0
Sex: M
Vaccine: FLU3, HPV2, FLU3, HPV4
Symptoms: Fall, Head injury, Loss of consciousness
Clinical narrative: Passed out at school. Fell off of desk chair and bump his head on desk next to him.
Age: 14.0
Sex: M
Vaccine: FLU3, HPV2, FLU3, HPV4
Symptoms: Erythema, Headache, Loss of consciousness, Mass
Clinical narrative: Passed out at school. Fell off of desk chair and bump his head on desk next to him.
Age: 1.09
Sex: F
Vaccine: MMR
Symptoms: Pyrexia, Rash, Somnolence
Clinical narrative: Rash began at 4pm.  I noticed a fever of 101at 9pm.  Fever of 102 through the night. 3/21/2011 woke up with more bumps (looked like bites) and still have a fever.  Fever all day, 4 hour nap in the afternoon (very unusual) and she probably would have slept longer if I hadn't gone in to her room.  Fever of 99.2 before bed.  Slept until 8am 3/22/2011, normally up by 6:30am, got to my mom's (sitter for the day) at 8:30am and she already looked like she was ready to go back to sleep.
Age: 0.38
Sex: F
Vaccine: PNC13
Symptoms: Irritability
Clinical narrative: 6 hours of significant fussiness following PREVNAR 13. No localized reaction.
Age: 22.0
Sex: F
Vaccine: FLUX, TDAP
Symptoms: Cellulitis, Erythema, Oedema peripheral
Clinical narrative: Initial report was received on 11 March 2011 from a health care professional. A 22 year-old female patient with no reported past medical history, had received a left arm injection of ADACEL, lot number C3728BA (route and exact date of administration not reported) and a left arm injection of Influenza vaccine (manufacturer, lot number, route and exact date of administration not reported) on the same date and an unspecified amount of time later experienced an "arm swollen, red with severe cellulitis". The patient was hospitalized ten days after vaccination. The reporter questions a response to the acellular pertussis portion of the vaccine. Treatments were not reported. No further information was available at the time of the report. The patient's outcome was not reported. Documents held by sender: none.
Age: 25.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Condition aggravated, Echocardiogram normal, Electrocardiogram, Lumbar puncture, Nuclear magnetic resonance imaging brain
Clinical narrative: This study case was received from the investigator in the above mentioned trial on 16 March 2011. A 25 year-old male subject with a medical history of pericarditis was found to have an unspecified disease of the pericardium 8 days after he had received an injection of ACAM2000 (lot number, route and site of administration not reported) and ANTHRAX 2 (manufacturer, lot number, route and site of administration not reported) on 29 June 2010. Relevant laboratory data included: an abnormal Troponin I with the highest recorded value of 00.10 and a normal Echocardiogram. The subject's ECG, MRI (brain, spinal cord and heart) and lumbar puncture were not available. Treatments were not reported. Additional information will be requested from the investigator. The subject's outcome was not reported. Note: There is no reporter causality assessment as this is a safety surveillance (data mining, non-interventional) study. Documents held by sender: none.
Age: 25.0
Sex: M
Vaccine: ANTH, SMALL
Symptoms: Pericardial disease, Troponin I increased
Clinical narrative: This study case was received from the investigator in the above mentioned trial on 16 March 2011. A 25 year-old male subject with a medical history of pericarditis was found to have an unspecified disease of the pericardium 8 days after he had received an injection of ACAM2000 (lot number, route and site of administration not reported) and ANTHRAX 2 (manufacturer, lot number, route and site of administration not reported) on 29 June 2010. Relevant laboratory data included: an abnormal Troponin I with the highest recorded value of 00.10 and a normal Echocardiogram. The subject's ECG, MRI (brain, spinal cord and heart) and lumbar puncture were not available. Treatments were not reported. Additional information will be requested from the investigator. The subject's outcome was not reported. Note: There is no reporter causality assessment as this is a safety surveillance (data mining, non-interventional) study. Documents held by sender: none.
Age: 1.35
Sex: M
Vaccine: DTAP, DTAP
Symptoms: Chest X-ray normal, Cough, Pertussis, Polymerase chain reaction, Post-tussive vomiting
Clinical narrative: This is one case out of a cumulative total of 14 pertussis cases received during the surveillance period from 01 January 2010 to 10 March 2011. Initial report received on 10 March 2011 from the Investigator participating in the post-marketing observation surveillance study under the reference number M5A16. A case of pertussis disease in a 3-year-old male subject (initials not collected) was identified by the investigator based on review of data from the Electronic Disease Surveillance System. The subject's vaccine history included four doses of DAPTACEL, lot number C2799AA received on 14 March 2008, lot number C2933AB received on 15 May 2008, lot number C2934AA received on 16 July 2008 and lot number C2956AA received on 30 April 2009 (routes and site of administration not reported). On 17 February 2011, approximately 21 months after the last dose, the subject developed a paroxysmal cough with a whoop. The subject also experienced posttussive vomiting and sleep disturbance. Laboratory testing included positive PCR on 02 March 2011. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of Amoxicillin starting on 17 February 2011 for 10 days. The subject was not hospitalized. At the time of final contact on 03 March 2011, the subject's cough was still persisting. The duration of the cough was reported at that time as 14 days. Investigator causality assessment is not required as per protocol. Documents held by sender: None.
Age: 1.35
Sex: M
Vaccine: DTAP, DTAP
Symptoms: Sleep disorder
Clinical narrative: This is one case out of a cumulative total of 14 pertussis cases received during the surveillance period from 01 January 2010 to 10 March 2011. Initial report received on 10 March 2011 from the Investigator participating in the post-marketing observation surveillance study under the reference number M5A16. A case of pertussis disease in a 3-year-old male subject (initials not collected) was identified by the investigator based on review of data from the Electronic Disease Surveillance System. The subject's vaccine history included four doses of DAPTACEL, lot number C2799AA received on 14 March 2008, lot number C2933AB received on 15 May 2008, lot number C2934AA received on 16 July 2008 and lot number C2956AA received on 30 April 2009 (routes and site of administration not reported). On 17 February 2011, approximately 21 months after the last dose, the subject developed a paroxysmal cough with a whoop. The subject also experienced posttussive vomiting and sleep disturbance. Laboratory testing included positive PCR on 02 March 2011. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of Amoxicillin starting on 17 February 2011 for 10 days. The subject was not hospitalized. At the time of final contact on 03 March 2011, the subject's cough was still persisting. The duration of the cough was reported at that time as 14 days. Investigator causality assessment is not required as per protocol. Documents held by sender: None.
Age: 1.35
Sex: M
Vaccine: DTAP, DTAP
Symptoms: Chest X-ray normal, Cough, Laboratory test abnormal, Pertussis, Polymerase chain reaction
Clinical narrative: This is one case out of a cumulative total of 14 pertussis cases received during the surveillance period from 01 January 2010 to 10 March 2011. Initial report received on 10 March 2011 from the Investigator participating in the post-marketing observation surveillance study under the reference number M5A16. A case of pertussis disease in a 3-year-old male subject (initials not collected) was identified by the investigator based on review of data from the Electronic Disease Surveillance System. The subject's vaccine history included four doses of DAPTACEL, lot number C2799AA received on 14 March 2008, lot number C2933AB received on 15 May 2008, lot number C2934AA received on 16 July 2008 and lot number C2956AA received on 30 April 2009 (routes and site of administration not reported). On 17 February 2011, approximately 21 months after the last dose, the subject developed a paroxysmal cough with a whoop. The subject also experienced posttussive vomiting and sleep disturbance. Laboratory testing included positive PCR on 02 March 2011. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of Amoxicillin starting on 17 February 2011 for 10 days. The subject was not hospitalized. At the time of final contact on 03 March 2011, the subject's cough was still persisting. The duration of the cough was reported at that time as 14 days. Investigator causality assessment is not required as per protocol. Documents held by sender: None.
Age: 1.35
Sex: M
Vaccine: DTAP, DTAP
Symptoms: Post-tussive vomiting, Sleep disorder
Clinical narrative: This is one case out of a cumulative total of 14 pertussis cases received during the surveillance period from 01 January 2010 to 10 March 2011. Initial report received on 10 March 2011 from the Investigator participating in the post-marketing observation surveillance study under the reference number M5A16. A case of pertussis disease in a 3-year-old male subject (initials not collected) was identified by the investigator based on review of data from the Electronic Disease Surveillance System. The subject's vaccine history included four doses of DAPTACEL, lot number C2799AA received on 14 March 2008, lot number C2933AB received on 15 May 2008, lot number C2934AA received on 16 July 2008 and lot number C2956AA received on 30 April 2009 (routes and site of administration not reported). On 17 February 2011, approximately 21 months after the last dose, the subject developed a paroxysmal cough with a whoop. The subject also experienced posttussive vomiting and sleep disturbance. Laboratory testing included positive PCR on 02 March 2011. Chest x-ray findings were negative for pneumonia. Corrective treatments consisted of Amoxicillin starting on 17 February 2011 for 10 days. The subject was not hospitalized. At the time of final contact on 03 March 2011, the subject's cough was still persisting. The duration of the cough was reported at that time as 14 days. Investigator causality assessment is not required as per protocol. Documents held by sender: None.
Age: 0.5
Sex: F
Vaccine: DTAPIPVHIB, HEP, PNC13, RV5
Symptoms: Convulsion
Clinical narrative: Patient experienced an afebrile seizure the evening of 3/15/11. She received the 6 month series of vaccines that morning.
Age: 4.0
Sex: M
Vaccine: MMR, VARCEL
Symptoms: Cough, Dizziness, Dyspnoea, Fatigue, Headache
Clinical narrative: High fever 103.8 102.4, headache, dizziness, fatigue, lethargic for 5 days, difficulty breathing & coughing.
Age: 4.0
Sex: M
Vaccine: MMR, VARCEL
Symptoms: Laboratory test, Lethargy, Pyrexia, X-ray
Clinical narrative: High fever 103.8 102.4, headache, dizziness, fatigue, lethargic for 5 days, difficulty breathing & coughing.
Age: 6.0
Sex: M
Vaccine: FLU3, MMRV
Symptoms: Oedema peripheral, Pyrexia
Clinical narrative: On 3-17-11 mom returned to clinic for additional vaccines and requested child not be given additional flu vaccine. Stated arm (L) was swollen the day following vaccines given on 2-8-11. States child had a fever up to 103 degrees orally for 2 days. Urgent care visit on 2-11-11. Mom states no treatment.
Age: 12.0
Sex: M
Vaccine: FLU3
Symptoms: Injection site erythema, Vaccination site swelling
Clinical narrative: On 3/14/11, mother noted that the patient had redness and swelling at the vaccination site. She states that the patient's armpit on the affected side appeared unusual. She was instructed to contact her primary care provider, who advised observation. This then resolved over the next two days.
Age: 37.0
Sex: F
Vaccine: FLU3
Symptoms: Arthralgia, Fatigue, Pain, Paraesthesia, Pyrexia
Clinical narrative: Several days after vaccination, fever, body aches, vomiting for 24 hours. Several weeks after tingling hands, fatigue, joint pain. Now with Dx RA.
Age: 37.0
Sex: F
Vaccine: FLU3
Symptoms: Rheumatoid arthritis, Rheumatoid factor positive, Vomiting
Clinical narrative: Several days after vaccination, fever, body aches, vomiting for 24 hours. Several weeks after tingling hands, fatigue, joint pain. Now with Dx RA.
Age: 0.49
Sex: F
Vaccine: FLU3
Symptoms: No adverse event
Clinical narrative: No events. Vaccine was administered before 6 mo old (3 days before turning 6 months).
Age: 37.0
Sex: M
Vaccine: FLU3, HEPA, TYP
Symptoms: Contusion
Clinical narrative: 6cm x 5cm bruise 7 inches below injection site x 2 days post inject.
Age: 1.72
Sex: F
Vaccine: DTAP, HEPA, PNC13
Symptoms: Injection site urticaria, Urticaria
Clinical narrative: Mother noticed hives appearing on right thigh the morning after vaccinations.  The hives spread to groin, trunk, and face.  She brought her daughter to the pediatrician that morning.
Age: 72.0
Sex: F
Vaccine: VARZOS
Symptoms: Rash
Clinical narrative: Patient noticed a slightly raised rash under arm, around to breast and up shoulder two days after injection. Patient went to physician 6 days after injection and at visit it was undetermined if was an allergy to vaccine or not. Patient received an oral steroid - stated rash was better after first day of treatment.
Age: 18.0
Sex: F
Vaccine: MNQ
Symptoms: Erythema, Tuberculin test
Clinical narrative: Initial report received from a health care professional (nurse) on 02 Mar 2011: This patient was vaccinated with MENVEO (batch number: A1000027), 0.5 ml intramuscularly on 24 Feb 2011.  On 25 Feb 2011, the patient developed redness and a possible cellulitis adjacent to the injection site.  The patient was treated with antibiotics.  The outcome of the event was reported as condition improving.  Follow-up report received from a physician on 09 Mar 2011: Patient's demographic updated.  She was concomitantly taking birth control pill daily and given 0.1 ml intradermal Tubersol PPD for screening of tuberculosis on 24 Feb 2011.  The patient was vaccinated with MENVEO into deltoid on 24 Feb 2011.  On 25 Feb 2011, she presented erythematous area below injection site.
Age: 30.0
Sex: M
Vaccine: PPV
Symptoms: Arthralgia, Injection site swelling, Lymph node pain, Nausea, Pyrexia
Clinical narrative: Swelling to (L) shoulder -> elbow with warmth/pain to touch. Tenderness to (L) axilla over lymph nodes. Nausea/fever/ no problems at injection site.
Age: 30.0
Sex: M
Vaccine: PPV
Symptoms: Skin warm
Clinical narrative: Swelling to (L) shoulder -> elbow with warmth/pain to touch. Tenderness to (L) axilla over lymph nodes. Nausea/fever/ no problems at injection site.
Age: 79.0
Sex: M
Vaccine: PPV
Symptoms: Computerised tomogram, Injection site erythema, Injection site haematoma, Injection site pain, Injection site swelling
Clinical narrative: Pt. reported red swollen (L) upper arm to nurses on 3/16/11 at 8:30A no other acute distress. Appt. arranged with Dr. at 9:30-10:00. Examined at 10AM. Bruising at antecubital, red, swollen tender to touch L. upper arm since last evening. On 3/14/11 had CT scan dye (L) AC site, BENADRYL 50 mg IM and PNEUMOVAX 23 IM (L) delt. No dyspnea, fever, chills or other systemic symptoms. Temp 98.5 110/66, 88 reg. 18 resp. Advised ice pack to site at intervals - watch for elevated temp. and chills.
Age: 79.0
Sex: M
Vaccine: PPV
Symptoms: Scan with contrast
Clinical narrative: Pt. reported red swollen (L) upper arm to nurses on 3/16/11 at 8:30A no other acute distress. Appt. arranged with Dr. at 9:30-10:00. Examined at 10AM. Bruising at antecubital, red, swollen tender to touch L. upper arm since last evening. On 3/14/11 had CT scan dye (L) AC site, BENADRYL 50 mg IM and PNEUMOVAX 23 IM (L) delt. No dyspnea, fever, chills or other systemic symptoms. Temp 98.5 110/66, 88 reg. 18 resp. Advised ice pack to site at intervals - watch for elevated temp. and chills.
Age: 13.0
Sex: F
Vaccine: VARCEL
Symptoms: Varicella
Clinical narrative: Atypical varicella post vaccinated vaccines given 10/21/98 #1 & again 7/9/07 #2.
Age: 12.0
Sex: U
Vaccine: FLU3, MNQ
Symptoms: Unevaluable event
Clinical narrative: None.
Age: 69.0
Sex: F
Vaccine: VARZOS
Symptoms: Contusion, Injection site pain
Clinical narrative: Bruising, pain at injection site.
Age: 0.9
Sex: M
Vaccine: DTAP
Symptoms: Condition aggravated, Convulsion, Crying
Clinical narrative: Seizures he had a seizure after taking Dtap and cried for 3 hrs., just like the rules they gave up, says he is 1 child in 14,000, he has had all his shots up to date. It was in July, so we didn't give him this shot last time.
Age: 20.0
Sex: M
Vaccine: ANTH, SMALL, TYP, ANTH, SMALL, TYP
Symptoms: Erythema, Erythema multiforme, Rash pruritic, Skin lesion
Clinical narrative: 1 week after Smallpox and Anthrax and Typhoid vaccines developed red "target" lesions on hands, genitalia, and buttocks. Three weeks after vaccines rash gone from genitalia and improving on hands/buttocks. Rash itchy and appears to be Erythema Multiforme.
Age: 20.0
Sex: M
Vaccine: ANTH, SMALL, TYP, ANTH, SMALL, TYP
Symptoms: Erythema multiforme, Genital rash, Rash erythematous, Rash pruritic, Skin lesion
Clinical narrative: 1 week after Smallpox and Anthrax and Typhoid vaccines developed red "target" lesions on hands, genitalia, and buttocks. Three weeks after vaccines rash gone from genitalia and improving on hands/buttocks. Rash itchy and appears to be Erythema Multiforme.
Age: 4.0
Sex: F
Vaccine: DTAP, MMR, VARCEL
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
Clinical narrative: Red and swollen of (R) thigh, 10.5cm L x 12cm W. Warm to touch. Cephalexin 250/5 1 tsp TID x 10 days. BENADRYL 1 tsp every 6-8 hours for 24-48 hours. Ice, TYLENOL/ADVIL PRN.
Age: 53.0
Sex: F
Vaccine: TDAP
Symptoms: Injection site erythema, Injection site swelling
Clinical narrative: Erythema & swelling at injection site.
Age: 0.34
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC
Symptoms: Pyrexia
Clinical narrative: Fever.
Age: 39.0
Sex: M
Vaccine: TDAP
Symptoms: Electromyogram, Injection site atrophy, Injection site pain, Muscular weakness, Myalgia
Clinical narrative: Soreness (L) shoulder 1-2 weeks s/p vaccination then followed by "nerve pains". Pains/weakness of (L) tricep muscle progressively worsening over several months until presented to clinic on 2/14/2011. Atrophy of (L) tricep muscle. Sent to Dr for EMG studies.
Age: 39.0
Sex: M
Vaccine: TDAP
Symptoms: Nerve conduction studies, Neuralgia
Clinical narrative: Soreness (L) shoulder 1-2 weeks s/p vaccination then followed by "nerve pains". Pains/weakness of (L) tricep muscle progressively worsening over several months until presented to clinic on 2/14/2011. Atrophy of (L) tricep muscle. Sent to Dr for EMG studies.
Age: 1.0
Sex: F
Vaccine: HIBV, MMR, PNC13, VARCEL
Symptoms: Dyskinesia, Irritability, Pyrexia
Clinical narrative: 36 hours after vaccines with generalized body "jerking" 1x/hr x 4-5 times, mild fever, fussy.
Age: 47.0
Sex: F
Vaccine: HEPAB, TDAP, TYP, YF
Symptoms: Lymph node pain, Lymphadenopathy
Clinical narrative: 3/11/11 Lt. axillary lymph nodes swollen & painful tender, for a few days; mentioned it to Oncologist at Monday visit. Hx Breast Ca to Rt breast. Symptoms gone now. Said Oncologist not concerned felt due to vaccines.
Age: 72.0
Sex: F
Vaccine: VARZOS, VARZOS, VARZOS
Symptoms: Acupuncture, Arthralgia, Immediate post-injection reaction, Insomnia, Nervous system disorder
Clinical narrative: Symptoms started immediately (1) joint pain, increased threefold (2) nerves raw & irritating (3) no sleep - 1st week - continued (4) acupuncture & enzymes.
Age: 72.0
Sex: F
Vaccine: VARZOS, VARZOS, VARZOS
Symptoms: Arthralgia, Condition aggravated, Dyskinesia, Insomnia
Clinical narrative: Symptoms started immediately (1) joint pain, increased threefold (2) nerves raw & irritating (3) no sleep - 1st week - continued (4) acupuncture & enzymes.
Age: 72.0
Sex: F
Vaccine: VARZOS, VARZOS, VARZOS
Symptoms: Arthritis, Bone pain, Burning sensation, Condition aggravated, Hypoaesthesia
Clinical narrative: Symptoms started immediately (1) joint pain, increased threefold (2) nerves raw & irritating (3) no sleep - 1st week - continued (4) acupuncture & enzymes.
Age: 5.0
Sex: F
Vaccine: MMR
Symptoms: Abdominal discomfort, Diarrhoea, Pyrexia, Urticaria
Clinical narrative: Patient received MMR vaccine on 7/1/2010. She began running a fever (104.7) on July 11th and started to develop spots (hives). She saw the doctor on July 1th, which she was diagnosed with hives at that time (they were severe). Also, on July 4th patient complained of an upset stomach and had diarrhea.
Age: 18.0
Sex: F
Vaccine: MNQ
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
Clinical narrative: (L) shoulder with about 6cm x 6 cm area of redness, swelling & pain. School nurse gave MOTRIN & BENADRYL.
Age: 41.0
Sex: M
Vaccine: TDAP
Symptoms: Erythema, Injection site erythema, Rash erythematous
Clinical narrative: About 56 hrs after Tdap redness around injection site which was rounded and red. Red dots about "8" spread over my chest and below chest & above diaphragm. Also noted redness in inside elbows.
Age: 61.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
Clinical narrative: Pt received a ZOSTAVAX vaccine 3/8/2011. On 3/10 she returned to the pharmacy. Injection site was red, warm to touch, raised & red. She was instructed to apply ice, take TYLENOL. 3/17 we followed up with phone call, area is still red, not warm, no raised area. We asked her to call if situation gets worse.
Age: 4.0
Sex: F
Vaccine: DTAP, IPV, MMRV
Symptoms: Injection site erythema, Injection site macule, Injection site warmth
Clinical narrative: 8.0 cm x 8.0 cm warm, erythematous macule (R) upper arm.
Age: 0.42
Sex: F
Vaccine: DTAPIPVHIB, HIBV, PNC13, RV5
Symptoms: Abdominal pain, Culture stool negative, Diarrhoea, Haematochezia, Ultrasound scan normal
Clinical narrative: Diarrhea stools with blood and abdominal cramps started at 6:00am. She began began vomiting at 12:0050 PM.  She came in to the office and was referred to ER.
Age: 0.42
Sex: F
Vaccine: DTAPIPVHIB, HIBV, PNC13, RV5
Symptoms: Vomiting
Clinical narrative: Diarrhea stools with blood and abdominal cramps started at 6:00am. She began began vomiting at 12:0050 PM.  She came in to the office and was referred to ER.
Age: 11.0
Sex: F
Vaccine: HEP, IPV, TD
Symptoms: Ear pain, Headache, Local swelling, Oropharyngeal pain, Pain
Clinical narrative: C/O generalized rash, sore throat, pain and swelling of neck. c/o headache, and ear pain as well.
Age: 11.0
Sex: F
Vaccine: HEP, IPV, TD
Symptoms: Rash generalised
Clinical narrative: C/O generalized rash, sore throat, pain and swelling of neck. c/o headache, and ear pain as well.
Age: 4.0
Sex: M
Vaccine: DTAPIPVHIB, HEPA, MMR, PNC13, VARCEL
Symptoms: Erythema, Skin warm
Clinical narrative: NOTICED RED, WARM RAISED AREA FROM SHOULDER AREA TO 3/4 DOWN ARM AND COVERED FROM FRONT BICEP AREA TO TRICEP AREA. DIDN'T USE ANY CREAMS ETC. DIDN'T WANT TO MAKE IT WORSE. MOM STATES MUCH IMPROVED TODAY ON LIGHT RED COLOR AND NOT WARM TO AFFECTED AREAS
Age: 46.0
Sex: F
Vaccine: FLU3
Symptoms: Electrocardiogram normal, Hypoaesthesia, Hypoaesthesia facial, Hypoaesthesia oral, Neurological examination normal
Clinical narrative: Numbness of neck/shoulders, face, lips, hands and slightly at chest.  Also strange tingling sensation and slight itching in those areas. Numbness would come and go at different times from day to day. Symptoms seemed to peak after about 6-8 weeks and then lessened and lessened. Achy allover too.
Age: 46.0
Sex: F
Vaccine: FLU3
Symptoms: Nuclear magnetic resonance imaging normal, Paraesthesia, Pruritus
Clinical narrative: Numbness of neck/shoulders, face, lips, hands and slightly at chest.  Also strange tingling sensation and slight itching in those areas. Numbness would come and go at different times from day to day. Symptoms seemed to peak after about 6-8 weeks and then lessened and lessened. Achy allover too.
Age: 1.28
Sex: F
Vaccine: DTAP, HEPA, HIBV, MMR, PPV
Symptoms: Aphasia, Decreased eye contact, Laboratory test, Pyrexia, Vomiting
Clinical narrative: Gradual decline in speech and eye contact 2 months prior to this date.. was admitted to ER for uncontrollable vomiting and fever..
Age: 1.02
Sex: F
Vaccine: FLU3, HIBV, MMR, VARCEL
Symptoms: Rash maculovesicular, Rash papular, Skin lesion, Upper respiratory tract infection, Varicella
Clinical narrative: Development of varicella 5 years after receiving only one dose of varicella vaccine. Mother exercises personal belief exemption in completing vaccines. Onset of Upper respiratory symptoms about 1 week ago. Rapid onset of maculo-papulo-vesicular lesions on back, torso, scalp and arms
Age: 57.0
Sex: M
Vaccine: FLUX
Symptoms: Dermatitis allergic, Rash erythematous, Rash pruritic
Clinical narrative: Patient developed a diffuse, bilateral, fine pink rash that was raised, red, and itching.  Physician's impression was typical allergic dermatitis.  Patient given prescription of Atarax 25mg.
Age: 35.0
Sex: M
Vaccine: FLU3
Symptoms: Angiotensin converting enzyme, Antibody test negative, Antinuclear antibody negative, Blood magnesium normal, Blood phosphorus normal
Clinical narrative: Lt. side facial palsy, treated with Valacyclovir 1gm x3 and prednisone 60mg/day for 10 days. Then Rt. side facial palsy on 02/01/2011, treated with Famcyclovir 500mg x3 and 80mg/day prednisone. then relapse on Rt side on 03/05/2011 also treated with Famcyclovir 500mg x3 and 80mg/day prednisone.
Age: 35.0
Sex: M
Vaccine: FLU3
Symptoms: Borrelia test negative, C-reactive protein normal, Full blood count normal, HIV antibody negative, Liver function test normal
Clinical narrative: Lt. side facial palsy, treated with Valacyclovir 1gm x3 and prednisone 60mg/day for 10 days. Then Rt. side facial palsy on 02/01/2011, treated with Famcyclovir 500mg x3 and 80mg/day prednisone. then relapse on Rt side on 03/05/2011 also treated with Famcyclovir 500mg x3 and 80mg/day prednisone.
Age: 35.0
Sex: M
Vaccine: FLU3
Symptoms: Metabolic function test normal, Nuclear magnetic resonance imaging brain normal, Platelet count normal, Red blood cell sedimentation rate normal, Rheumatoid factor negative
Clinical narrative: Lt. side facial palsy, treated with Valacyclovir 1gm x3 and prednisone 60mg/day for 10 days. Then Rt. side facial palsy on 02/01/2011, treated with Famcyclovir 500mg x3 and 80mg/day prednisone. then relapse on Rt side on 03/05/2011 also treated with Famcyclovir 500mg x3 and 80mg/day prednisone.
Age: 35.0
Sex: M
Vaccine: FLU3
Symptoms: Treponema test negative, VIIth nerve paralysis
Clinical narrative: Lt. side facial palsy, treated with Valacyclovir 1gm x3 and prednisone 60mg/day for 10 days. Then Rt. side facial palsy on 02/01/2011, treated with Famcyclovir 500mg x3 and 80mg/day prednisone. then relapse on Rt side on 03/05/2011 also treated with Famcyclovir 500mg x3 and 80mg/day prednisone.
Age: 26.0
Sex: M
Vaccine: DTAP
Symptoms: Chills, Nausea, Pain, Pyrexia, Vomiting
Clinical narrative: Nausea, Vomiting, Chills, Fever, Body Aches
Age: 4.0
Sex: M
Vaccine: DTAP, IPV, PNC13, VARCEL
Symptoms: Chills, Loss of consciousness, Skin discolouration, Speech disorder, Vomiting
Clinical narrative: About 10 minutes after the shots I was holding my son.  He started shivering and then passed out.  The doctor laid him on a table.  He lost all color in his skin and wouldn't talk.  About 20 minutes later he was looking better and then vomited a lot.  He needed to rest for about 20 more minutes.  As of now (this was this morning) he is okay.
Age: 76.0
Sex: M
Vaccine: VARZOS
Symptoms: Rash vesicular, Tenderness
Clinical narrative: Tenderness in back and under left breast; two spots that look like insect bites (pt reports that it doesn't appear like a rash) could be varicella-related rash.
Age: 1.0
Sex: F
Vaccine: FLU3, HEPA, MMR, VARCEL
Symptoms: Injection site cellulitis, Injection site streaking
Clinical narrative: About 4 days post vaccinations small streak about 1" on (L) thigh - this area darkened & enlarged. Seen while traveling for what was diagnosed as cellulitis & 7 day course of antibiotics was ordered on 3/21/11. Site is improving today. Child is not otherwise ill.
Age: 0.53
Sex: M
Vaccine: DTAPHEPBIP, RV5
Symptoms: Pyrexia
Clinical narrative: Fever Tm 105.0 (R) -> started at 12 hrs. after & lasted < 24 hrs. Was given Acetaminophen/Ibuprofen - alternating every 3 hrs. to try & keep fever under control.
Age: 31.0
Sex: M
Vaccine: MNQ
Symptoms: Asthenia, Fatigue, Injection site pain, Pyrexia
Clinical narrative: Rec'd MENACTRA 2-21-11. On 2-22-11 patient stated he had fever 100 F, fatigue, decreased energy and injection site soreness. 2-23-11 States symptoms subsided except some tenderness at injection site.
Age: 1.04
Sex: F
Vaccine: FLU3, MMR, PNC13, FLU3, MMR, PNC13
Symptoms: Central venous catheterisation, Chest X-ray abnormal, Chest tube insertion, Cough, Dyspnoea
Clinical narrative: Started 02/19 w/ runny nose, 02/20 low grade fever, 02/21 started breathing retractions, brought to ER, identified right side pneumonia, treated w/ albuterol, and chest PT.  Transfered to medical center, 02/22 developed medium to large sized pneumothorax on right side.    Developed acute respiratory failure and intubated for 48 hours.  Chest tube and central line were also placed in patient. Dr diagnosis bronchiolitis, pneumonia, pnuemonthorax, and respiratory failure. Pneumonthorax resolved after 4 days.
Age: 1.04
Sex: F
Vaccine: FLU3, MMR, PNC13, FLU3, MMR, PNC13
Symptoms: Endotracheal intubation, Nasal congestion, Pneumonia, Pneumothorax, Pyrexia
Clinical narrative: Started 02/19 w/ runny nose, 02/20 low grade fever, 02/21 started breathing retractions, brought to ER, identified right side pneumonia, treated w/ albuterol, and chest PT.  Transfered to medical center, 02/22 developed medium to large sized pneumothorax on right side.    Developed acute respiratory failure and intubated for 48 hours.  Chest tube and central line were also placed in patient. Dr diagnosis bronchiolitis, pneumonia, pnuemonthorax, and respiratory failure. Pneumonthorax resolved after 4 days.
Age: 1.04
Sex: F
Vaccine: FLU3, MMR, PNC13, FLU3, MMR, PNC13
Symptoms: Rash
Clinical narrative: Started 02/19 w/ runny nose, 02/20 low grade fever, 02/21 started breathing retractions, brought to ER, identified right side pneumonia, treated w/ albuterol, and chest PT.  Transfered to medical center, 02/22 developed medium to large sized pneumothorax on right side.    Developed acute respiratory failure and intubated for 48 hours.  Chest tube and central line were also placed in patient. Dr diagnosis bronchiolitis, pneumonia, pnuemonthorax, and respiratory failure. Pneumonthorax resolved after 4 days.
Age: 1.04
Sex: F
Vaccine: FLU3, MMR, PNC13, FLU3, MMR, PNC13
Symptoms: Acute respiratory failure, Alpha-1 anti-trypsin normal, Bronchiolitis, Chest tube insertion, Endotracheal intubation
Clinical narrative: Started 02/19 w/ runny nose, 02/20 low grade fever, 02/21 started breathing retractions, brought to ER, identified right side pneumonia, treated w/ albuterol, and chest PT.  Transfered to medical center, 02/22 developed medium to large sized pneumothorax on right side.    Developed acute respiratory failure and intubated for 48 hours.  Chest tube and central line were also placed in patient. Dr diagnosis bronchiolitis, pneumonia, pnuemonthorax, and respiratory failure. Pneumonthorax resolved after 4 days.
Age: 1.04
Sex: F
Vaccine: FLU3, MMR, PNC13, FLU3, MMR, PNC13
Symptoms: Influenza virus test negative, Laboratory test normal, Pneumonia, Pneumothorax, Pyrexia
Clinical narrative: Started 02/19 w/ runny nose, 02/20 low grade fever, 02/21 started breathing retractions, brought to ER, identified right side pneumonia, treated w/ albuterol, and chest PT.  Transfered to medical center, 02/22 developed medium to large sized pneumothorax on right side.    Developed acute respiratory failure and intubated for 48 hours.  Chest tube and central line were also placed in patient. Dr diagnosis bronchiolitis, pneumonia, pnuemonthorax, and respiratory failure. Pneumonthorax resolved after 4 days.
Age: 1.04
Sex: F
Vaccine: FLU3, MMR, PNC13, FLU3, MMR, PNC13
Symptoms: Respiratory syncytial virus test negative, Rhinorrhoea, Use of accessory respiratory muscles
Clinical narrative: Started 02/19 w/ runny nose, 02/20 low grade fever, 02/21 started breathing retractions, brought to ER, identified right side pneumonia, treated w/ albuterol, and chest PT.  Transfered to medical center, 02/22 developed medium to large sized pneumothorax on right side.    Developed acute respiratory failure and intubated for 48 hours.  Chest tube and central line were also placed in patient. Dr diagnosis bronchiolitis, pneumonia, pnuemonthorax, and respiratory failure. Pneumonthorax resolved after 4 days.
Age: 5.0
Sex: F
Vaccine: DTAPIPV, MMRV, DTAPIPV, MMRV
Symptoms: Computerised tomogram head, Full blood count, Guillain-Barre syndrome, Immunoglobulin therapy, Lumbar puncture
Clinical narrative: Fever, vomiting, avoiding walking, bilateral foot & leg pain, restless, leg weakness. She has been dx with Guillain Barre Syndrome and is currently in hospital on IVIG. (This may be post flu and not related to shots).
Age: 5.0
Sex: F
Vaccine: DTAPIPV, MMRV, DTAPIPV, MMRV
Symptoms: Metabolic function test, Muscular weakness, Pain, Pain in extremity, Pyrexia
Clinical narrative: Fever, vomiting, avoiding walking, bilateral foot & leg pain, restless, leg weakness. She has been dx with Guillain Barre Syndrome and is currently in hospital on IVIG. (This may be post flu and not related to shots).
Age: 5.0
Sex: F
Vaccine: DTAPIPV, MMRV, DTAPIPV, MMRV
Symptoms: Restlessness, Vomiting
Clinical narrative: Fever, vomiting, avoiding walking, bilateral foot & leg pain, restless, leg weakness. She has been dx with Guillain Barre Syndrome and is currently in hospital on IVIG. (This may be post flu and not related to shots).
Age: 5.0
Sex: F
Vaccine: DTAPIPV, MMRV, DTAPIPV, MMRV
Symptoms: Metabolic function test, Muscular weakness, Pain in extremity, Pyrexia, Restlessness
Clinical narrative: Fever, vomiting, avoiding walking, bilateral foot & leg pain, restless, leg weakness. She has been dx with Guillain Barre Syndrome and is currently in hospital on IVIG. (This may be post flu and not related to shots).
Age: 5.0
Sex: F
Vaccine: DTAPIPV, MMRV, DTAPIPV, MMRV
Symptoms: Vomiting
Clinical narrative: Fever, vomiting, avoiding walking, bilateral foot & leg pain, restless, leg weakness. She has been dx with Guillain Barre Syndrome and is currently in hospital on IVIG. (This may be post flu and not related to shots).
Age: 15.0
Sex: M
Vaccine: TDAP, VARCEL
Symptoms: Dyskinesia, Tremor
Clinical narrative: unilateral leg shaking/jerking