DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE FOOD AND DRUG ADMINISTRATION / CENTERS FOR DISEASE CONTROL VACCINE ADVERSE EVENT REPORTING SYSTEM (VAERS) (revised June 2007) Contents: ·Important information about VAERS ·Brief Description of VAERS ·VAERS Data Should be Interpreted with Caution ·Description of Data Files ·Definitions of Terms Used in Data Files ·Commonly Used Symptom Text Abbreviations 1.Important Information About the Vaccine Adverse Event Reporting System (VAERS) VAERS was created by the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) to receive reports about adverse events that may be associated with vaccines. No prescription drug or biological product, such as a vaccine, is completely free from side effects. Vaccines protect many people from dangerous illnesses, but vaccines, like drugs, can cause side effects, a small percentage of which may be serious. VAERS is used to continually monitor reports to determine whether any vaccine or vaccine lot has a higher than expected rate of events. Doctors and other vaccine providers are encouraged to report adverse events, even if they are not certain that the vaccination was the cause. Since it is difficult to distinguish a coincidental event from one truly caused by a vaccine, the VAERS database will contain events of both types. In addition, it is often the case that more than one vaccine was administered, making it difficult to know to which of the vaccines the event might be attributed. In analyzing individual reports, researchers examine the medical information about the event, and obtain more specific information from the reporters whenever necessary. Patterns of reporting associated with vaccines and vaccine lots are also analyzed. More than 80% of vaccine adverse event reports concern relatively minor events, such as fevers or redness and swelling at the injection site. The remaining reports (less than 20%) describe serious events, such as hospitalizations, life-threatening illnesses, or deaths. The reports of serious events are of greatest concern and receive the most careful scrutiny by VAERS staff. VAERS researchers apply procedures and methods of analysis to help us closely monitor the safety of vaccines. When a concern arises, action is taken. We hope that this brief explanation of the factors associated with vaccines and adverse events will assist you in understanding the data you are viewing. Requests for additional information should be addressed to: Freedom of Information Staff, HFI-35 Food and Drug Administration 5600 Fishers Lane Rockville, MD 20857 2.Brief Description of VAERS The U.S. Department of Health and Human Services (DHHS) established the Vaccine Adverse Event Reporting System (VAERS), which is co-administered by the Food and Drug Administration (FDA) and the Centers for Disease Control (CDC), to accept all reports of suspected adverse events, in all age groups, after the administration of any U.S. licensed vaccine. On November 1, 1990 VAERS replaced CDC's Monitoring System for Adverse Events Following Immunization (MSAEFI) for public sector reporting and FDA's Spontaneous Reporting System for private sector and manufacturer reporting. The primary purpose for maintaining the database is to serve as an early warning or signaling system for adverse events not detected during pre-market testing. In addition, the National Childhood Vaccine Injury Act of 1986 (NCVIA) requires health care providers and vaccine manufacturers to report to the DHHS specific adverse events following the administration of those vaccines outlined in the Act. All reports are coded and entered into the VAERS database. The adverse events described in each report were coded utilizing the FDA's Coding Symbols for a Thesaurus of Adverse Reaction Terms (COSTART) from November 1990 until January 16 2007. On January 17 2007 the VAERS coding system was converted to an international coding system that is used worldwide. This system is called the Medical Dictionary for Regulatory Activities (MedDRA). The MedDRA coding system uses key words representing the medical condition(s) described in the case report and converts them to standardized codes. An individual VAERS report in these files may include up to a total of 8 vaccines administered and 20 MedDRA terms describing the event. The MedDRA codes provided in the dataset are called the "Preferred Terms"; there are more than 17,000 Preferred Term codes in the MedDRA system. The MedDRA coding system is more detailed than the COSTART system, which is comprised of 5,817 codes. Therefore the MedDRA system is not only standardized for international use, it is also able to code medical terms in a more exacting manner than the COSTART system design. All the COSTART codes that were used in the VAERS data prior to (January 17, 2007) have been converted to MedDRA coding terms. The MedDRA coding system is updated semi-annually, and terms may be added, deleted or changed with each new release. VAERS reports are coded using the MedDRA version in effect at the time the codes are entered; therefore, different terms may be used to describe similar events in reports coded at different times. If you desire more information about MedDRA, please visit the following web site: http://www.meddramsso.com/MSSOWeb/index.htm. 3.VAERS Data Should be Interpreted with Caution ·VAERS data are from a passive surveillance system and represent unverified reports of health events that occur after vaccination. Such data are subject to limitations of under-reporting, simultaneous administration of multiple vaccine antigens, reporting bias, and lack of incidence rates in unvaccinated comparison groups. ·When reporting and evaluating data from VAERS, it is important to note that for any reported event, no cause and effect relationship has been established. The event may have been related to an underlying disease or condition, to medications being taken concurrently, or may have occurred by chance. ·A report often involves more than one vaccine and may involve more than one reported adverse event. ·In certain cases VAERS requests additional information from reporters, healthcare providers and other parties. The status, event description and medical codes associated with a report are subject to change upon receipt of such additional information. ·When multiple reports of a single case or event are received, only the first report received is included in the publicly accessible dataset. Subsequent reports may contain additional or conflicting data, and there is no assurance that the data provided in the public dataset is the most accurate or current available. ·A given report may meet more than one criterion for classification as "serious." ·Accumulations of events reported to a passive surveillance system do not allow incidence rate calculations due to the generally unknown extent of under-reporting as well as lack of information on the number of people being vaccinated. 4.Description of Data Files VAERS data is accessible by two mechanisms: by downloading raw data in comma-separated value (CSV) files for import into a database, spreadsheet or text editing program, or by use of the CDC WONDER online search tool. The downloadable VAERS public data set consists of two separate data files. These files are provided by calendar year beginning with the first VAERS reports reported in the latter part of 1990. The public data set is updated on a monthly basis. In the following tables, "Box" refers to the numbered items or "boxes" on the VAERS form. Comma-separated-value (CSV) files are industry-standard text files compatible with most of the major database or statistical analysis products on the market. Each data set is available for download in 2 formats: as a pair of CSV files, or as a compressed Zip file that contains the two CSV files listed for the specific year. CDC WONDER, developed by the Centers for Disease Control and Prevention (CDC), is an easy-to-use, menu-driven system requiring no computer expertise or special software, that provides access to a wide array of public health information. With CDC WONDER you can produce tables, maps, charts and data extracts showing the incidence of vaccine adverse events, and select specific event, vaccine and demographic criteria to produce cross-tabulated incidence measures. You can also limit and index your data by several variables. VAERS data is available on CDC WONDER at http://wonder.cdc.gov/vaers.html. Additional information about CDC WONDER is available at http://wonder.cdc.gov/wonder/help/vaers.html. 4.1 VAERSDATA.CSV The following table provides a detailed description of the data provided in each field of the VAERSDATA.CSV file. Each row in the table refers to a separate field (or column) in the data. The "Header" provides the field name or column "header." "Type" describes the type of data contained in the data field. The information in parenthesis specifies the data format or number of digits or characters contained in the field. There are three data types: NUM = numeric data; CHAR = text or "character" data; and DATE = date fields in mm/dd/yy format. With the exception of the first two fields, each row in the table pertains to information recorded in (or derived from) the various numbered sections of the VAERS-1 form. No data is provided that would allow identification of any individuals associated with these reports. Header Type Description of Contents ----------------------------------------------------------------------------- VAERS_ID Num(6) VAERS Identification Number RECVDATE Date Date report was received STATE Char(2) Box 1: State AGE_YRS Num(xxx.x) Box 4: Age in Years CAGE_YR Num(xx) Age of patient in years calculated by (vax_date-birthdate) CAGE_MO Num(xx) Age of patient in months calculated by (vax_date-birthdate) SEX Char(1) Box 5: Sex RPT_DATE Date Box 6: Date Form Completed SYMPTOM_TEXT Char(2048) Box 7: Reported symptom text SYM_CNT Num(2) MedDRA Symptom Count SYM01 Char(100) Box 7a: Adverse Event Term #1 SYM02 Char(100) Box 7b Adverse Event MedDRA Term #2 SYM03 Char(100) Box 7c Adverse Event MedDRA Term #3 SYM04 Char(100) Box 7d: Adverse Event MedDRA Term #4 SYM05 Char(100) Box 7e: Adverse Event MedDRA Term #5 SYM06 Char(100) Box 7f: Adverse Event MedDRA Term #6 SYM07 Char(100) Box 7g: Adverse Event MedDRA Term #7 SYM08 Char(100) Box 7h: Adverse Event MedDRA Term #8 SYM09 Char(100) Box 7i: Adverse Event MedDRA Term #9 SYM10 Char(100) Box 7j: Adverse Event MedDRA Term #10 SYM11 Char(100) Box 7k: Adverse Event MedDRA Term #11 SYM12 Char(100) Box 7l: Adverse Event MedDRA Term #12 SYM13 Char(100) Box 7m: Adverse Event MedDRA Term #13 SYM14 Char(100) Box 7n: Adverse Event MedDRA Term #14 SYM15 Char(100) Box 7o: Adverse Event MedDRA Term #15 SYM16 Char(100) Box 7p: Adverse Event MedDRA Term #16 SYM17 Char(100) Box 7q: Adverse Event MedDRA Term #17 SYM18 Char(100) Box 7r: Adverse Event MedDRA Term #18 SYM19 Char(100) Box 7s: Adverse Event MedDRA Term #19 SYM20 Char(100) Box 7t: Adverse Event MedDRA Term #20 DIED Char(1) Box 8a1: Died ('Y' - Yes) DATEDIED Date Box 8a2: Date of Death L_THREAT Char(1) Box 8b: Life-Threatening Illness ('Y' - Yes) ER_VISIT Char(1) Box 8c: Emergency Room or Doctor Visit ('Y' - Yes) HOSPITAL Char(1) Box 8d1: Hospitalized ('Y' - Yes) HOSPDAYS Num(3) Box 8d2: Number of days Hospitalized X_STA Char(1) Box 8e: Prolonged Hospitalization ('Y' - Yes) DISABLE Char(1) Box 8f: Disability ('Y' - Yes) RECOVD Char(1) Box 9: Recovered ('Y' - Yes, 'N' - No, 'U' - Unknown) VAX_DATE Date Box 10: Vaccination Date ONSET_DATE Date Box 11: Adverse Event Onset Date NUMDAYS Num(5) Number of days (Onset date - Vax. Date) LAB_DATA Char(240) Box 12: Diagnostic laboratory data VAX_CNT Num(2) Box 13: Vaccine Count VAX1 Char(6) Box 13a: Administered Vaccine #1 VAX2 Char(6) Box 13b: Administered Vaccine #2 VAX3 Char(6) Box 13c: Administered Vaccine #3 VAX4 Char(6) Box 13d: Administered Vaccine #4 VAX5 Char(6) Box 13e: Administered Vaccine #5 VAX6 Char(6) Box 13f: Administered Vaccine #6 VAX7 Char(6) Box 13g: Administered Vaccine #7 VAX8 Char(6) Box 13h: Administered Vaccine #8 V_ADMINBY Char(3) Box 15: Vaccines Administered at (PUB=Public, PVT=Private,OTH=Other, MIL=Military) V_FUNDBY Char(3) Box 16: Vaccines purchased with (PUB=Public, PVT=Private, OTH=Other, MIL=Military) funds OTHER_MEDS Char(240) Box 17: Other Medications CUR_ILL Char(128) Box 18: Current Illnesses HISTORY Char(240) Box 19: Pre-existing physician diagnosed allergies, birth defects, medical conditions PRIOR_VAX Char(128) Box 21: Prior Vaccination Event information SPLTTYPE Char(25) Box 24: Manufacturer Number 4.2 VAERSVAX.CSV The fields described in this table provide the remaining vaccine information (e.g., vaccine name, manufacturer, lot number, route, site, and number of previous doses administered), for each of the vaccines listed in Box 13 of the VAERS form. The VAX_TYPE field in this table should be linked to the VAX(#) field described in the VAERSDATA.CSV table in Section 4.1 above. For each of the up to 8 vaccines listed in the VAERSDATA.CSV table, there is a matching record in this file, identified by VAERS_ID and VAX_TYPE. Header Type Description of Contents -------------------------------------------------------------- VAERS_ID Num(6) VAERS Identification Number VAX_TYPE Char(6) Administered Vaccine Type VAX_MANU Char(16) Vaccine Manufacturer VAX_LOT Char(15) Manufacturer's Vaccine Lot VAX_DOSE Char(2) Number of previous doses administered VAX_ROUTE Char(2) Vaccination Route VAX_SITE Char(2) Vaccination Site VAX_NAME Char(50) Vaccination Name ------------------------------------------------------------------------------------- 5. Definitions of Terms Used in Data Files The following definitions pertain to the fields found in the VAERSDATA.CSV file described in section 4.1 above. 1) VAERS Identification Number (VAERS_ID): A sequentially assigned number used for identification purposes. 2) Receive Date (RECVDATE): The date the VAERS form information was received to our processing center. 3) State (STATE): The two-letter US Postal Service abbreviation for the home state of the vaccinee as noted in Box 1 on the VAERS form. Please note that all foreign reports are contained in a separate data file. 4) Age in Years (AGE_YRS): The recorded vaccine recipient's age, in years, from Box 4 of the VAERS form. 5) Age in Years(CAGE_YR): Age of patient in years calculated by (vax_date-birthdate) 6) Age in Months(CAGE_MO): Age of patient in months calculated by (vax_date-birthdate) 7) Sex (SEX): Sex of the vaccine recipient from Box 5 of the VAERS form (M = Male, F = Female, Unknown = Blank). 8) Date Form Completed (RPT_DATE): Date the VAERS forms was completed by the reporter, from Box 6 on the VAERS form. 9) Reported Symptom Text (SYMPTOM_TEXT): This is the symptom text recorded in Box 7. MedDRA Terms are derived from this text. 10) MedDRA Symptom Count (SYM_CNT): The total number of MedDRA codes derived from the Box 7 symptom text 11) Adverse Event MedDRA Terms (SYM##): While an unlimited number of MedDRA codes may be derived from the narrative text recorded in Box 7 of the VAERS form, a maximum of 20 MedDRA codes are made available in this file. MedDRA terms are provided in alphabetical order; no significance is to be derived from the placement of the term in the list. 12) Patient Outcomes: The reporter's assessment of the vaccine recipient outcome is recorded in Box 8 on the VAERS form. Selections checked in Box 8 determine whether a report is considered to be a non-serious report, a serious report, or a death report. Died (DIED): If the vaccine recipient died, a "Y" is placed in Box 8a1. Otherwise the field will be blank Date of Death: (DATEDIED): If the reporter checked that the vaccine recipient died, there is space in Box 8a2 to record the date of death. Otherwise the field will be blank. Life Threatening (L_THREAT): If the vaccine recipient had a life-threatening event associated with the vaccination, a "Y" is placed in Box 8b. Otherwise the field will be blank Emergency Room (ER_VISIT): If the vaccine recipient required an emergency room or doctor visit, a "Y" is placed in Box 8c. Otherwise the field will be blank. If this is the only Box 8 option checked, the report is not considered serious. Hospitalized (HOSPITAL): If the vaccine recipient was hospitalized as a result of the vaccination, a "Y" is placed in Box 8d1. Otherwise the field will be blank Days Hospitalized (HOSPDAYS): If the reporter checked that the vaccine recipient was hospitalized, space is provided in Box 8d2 to record the number of days hospitalized. Otherwise the field will be blank. Prolonged Hospitalization (X_STAY): If a patient's hospitalization is prolonged as a result of the adverse event associated with the vaccination, a "Y" will be placed in Box 8e. Otherwise the field will be blank. Disability (DISABLE): If the vaccine recipient was disabled as a result of the vaccination, a "Y" is placed in Box 8f. Otherwise the field will be blank 13) Recovered (RECOVD): A "Y" is placed in the field if the reporter checked on Box 9 of the VAERS form that the vaccine recipient recovered from the adverse event. "N" indicated that the vaccine has not recovered from the adverse event. "U" or blank indicates that the vaccine recipient's recovery status is unknown. 14) Vaccination Date (VAX_DATE): The date of vaccination as recorded in Box 10 of the VAERS form. 15) Onset Date (ONSET_DATE): The date of the onset of adverse event symptoms associated with the vaccination as recorded in Box 11 of the VAERS form. 16) Onset Interval (NUMDAYS): The calculated interval (in days) from the vaccination date to the onset date. 17) Relevant Diagnostic Tests/Laboratory Data (LAB_DATA): This text field contains narrative about any relevant diagnostic tests or laboratory results as recorded in Box 12 on the VAERS form. 18) Vaccine Count (VAX_CNT): The total number of different vaccines administered as noted in Box 13 of the VAERS form. This field does not include vaccines noted in Box 14 of the VAERS form. 19) Administered Vaccines (VAX##): The code associated with a maximum of eight vaccines recorded in Box 13 is provided in the next eight fields (Box 13a-13 f). The following Table provides an interpretation of the vaccine codes. Abbrev Vaccine Type --------------------------- 6VAX-F = DTAP + IPV + HEPB + HIB ADEN = ADENOVIRUS VACCINE LIVE ORAL TYPE 7 ANTH = ANTHRAX VACCINE BCG = BACILLUS CALMETTE-GUERIN VACCINE CEE = CENTRAL EUROPEAN ENCEPHALITIS CHOL = CHOLERA VACCINE DPIPV = DIPHTHERIA/PERTUSSIS/INACTIVATED POLIO VIRUS DPP = DIPHTHERIA/PERTUSSIS/POLIO (ORAL [LIVE OR INACTIVATED NOT NOTED]) DT = DIPHTHERIA AND TETANUS TOXOIDS, PEDIATRIC DTAP = DIPHTHERIA AND TETANUS TOXOIDS AND ACELLULAR PERTUSSIS VACCINE DTAPHEBIP = DTAP + HEPB + IPV DTIPV = DT-IPV COMBINED DT AND IPV VACCINE DTOX = DIPHTHERIA TOXOID DTP = DIPHTHERIA AND TETANUS TOXOIDS AND PERTUSSIS VACCINE DTPH = DIPHTHERIA, TETANUS TOX, PERTUSSIS,& HAEMOPHILUS DTPHEP = DIPHTHERIA/TETANUS/PERTUSSIS/HEPATITIS B DTPHIB = DTP + HIB DTPPHIB = DTP + IPV + ACT-HIB DTPIHI = DIPHTHERIA/TETANUS/WHOLE PERTUSSIS-INACTIVATED POLIO VIRUS-HAEMOPHILUS INFLUENZA B DTPIPV = DTP-IPV COMBINED DTP AND IPV VACCINE FLU = INFLUENZA VIRUS VACCINE FLUN = INFLUENZA VIRUS VACCINE (NASAL SPRAY) HBHEPB = HIBV + HEP HBPV = HAEMOPHILUS B POLYSACCHARIDE VACCINE HbVC = HEPATITIS B HEP = HEPATITIS B VIRUS VACCINE HEPA = HEPATITIS A HEPAB = HEPATITIS A + HEPATITIS B HIBV = HAEMOPHILUS B CONJUGATE VACCINE HPV = HUMAN PAPILLOMAVIRUS HPV4 = HUMAN PAPILLOVAVIRUS QUADRIVALENT IPV = POLIOVIRUS VACCINE INACTIVATED JEV = JAPANESE ENCEPHALITIS VIRUS VACCINE LYME = LYME DISEASE VACCINE MEA = MEASLES MEN = MENINGOCOCCAL POLYSACCHARIDE VACCINE MER = MEASLES AND RUBELLA VIRUS VACCINE, LIVE MM = MEASLES AND MUMPS VIRUS VACCINE, LIVE MMR = MEASLES, MUMPS AND RUBELLA VIRUS VACCINE, LIVE MMRV = MEASLES, MUMPS, ROUBELLA AND VARICELLA VACCINE LIVE MNC = MENINGOCOCCAL CONJUGATE VACCINE MNQ = MENINGOCOCCAL CONJUGATE VACCINE MR = MEASLES AND RUBELLA VIRUS VACCINE, LIVE MU = MUMPS VIRUS VACCINE, LIVE MUR = MUMPS AND RUBELLA VIRUS VACCINE, LIVE OPV = POLIOVIRUS VACCINE TRIVALENT, LIVE, ORAL PER = PERTUSSIS VACCINE PLAGUE = PLAGUE VACCINE PNC = PNEUMOCOCCAL 7-VALENT CONJUCATE VACCINE PPV = PNEUMOCOCCAL VACCINE, POLYVALENT RAB = RABIES VIRUS VACCINE ROT = ROTAVIRUS VACCINE ROTHB5 = ROTAVIRUS VACCINE RUB = RUBELLA RV = ROTAVIRUS SMALL = SMALLPOX VACCINE SSEV = SPRING/SUMMER ENCEPHALITIS VACCINE TBE = TICK-BORNE ENCEPHALITIS VACCINE TD = TETANUS AND DIPHTHERIA TOXOIDS, ADULT TDAP = TETANUS TOXOID, REDUCED DIPHTHERIA TOXOID AND ACELLULAR PERTUSSIS VACCINE, ADSORBED TTOX = TETANUS TOXOID TYP = TYPHOID VACCINE VARCEL = VARIVAX-VARICELLA VIRUS LIVE VARZOS = VARICELLA-ZOSTER VACCINE YF = YELLOW FEVER VACCINE 20) Vaccine Administered at (V_ADMINBY): The reporter may note in Box 15 the type of facility administering the vaccine (PUB=Public, PVT=Private, MIL=Military; OTH Other/unknown) 21) Vaccine Purchased with (V_FUNDBY): The reporter may note in Box 16 on the VAERS form which type of funds were used to purchase the vaccines administered in Box 13 (PUB=Public, PVT=Private, MIL=Military; OTH Other/unknown). 22) Other Medications (OTHER_MEDS): This text field contains narrative about any prescription or non-prescription drugs the vaccine recipient was taking at the time of vaccination as recorded in Box 17 of the VAERS form. 23) Current Illnesses (CUR_ILL): This text field contains narrative about any illnesses at the time of the vaccination as noted in Box 18 of the VAERS form. 24) Pre-existing Conditions (HISTORY): This text field contains narrative about any pre-existing physician-diagnosed allergies, birth defects, medical condition that existed at the time of vaccination as noted in Box 19 of the VAERS form. 25) Prior Vaccination Event Information (PRIOR_VAX): This field provides prior vaccination event information recorded in Box 21 on the VAERS form. 26) Manufacturer Number (SPLTTYPE): Manufacturer number or Immunization Project number from Box 24. The following definitions pertain to the fields found in the VAERSVAX.CSV file described in section 4.2 above. 27) Vaccine Type (VAX_TYPE): The data in this field corresponds to the VAX[n] field from the VAERSDATA.CSV file described in Section 4.1 above (e.g., FLU, DTAP). 28) Vaccine Manufacturer (VAX_MANU): This field identifies the manufacturer of the each of the vaccines listed Box 13 of the VAERS form. 29) Manufacturers Vaccine Lot (VAX_LOT): This field identified the lot number of the vaccines listed in Box 13 of the VAERS form. 30) Vaccine Dose (VAX_DOSE): This field identifies the vaccine dose recorded in Box 13 of the VAERS form. 31) Vaccination Route (VAX_ROUTE): This field identifies the vaccine route of administration as noted in Box 13 of the VAERS form. 32) Vaccination Site (VAX_SITE): This field identified the anatomic site where the vaccination was administered as noted on Box 13 of the VAERS form. 33) Vaccine Name (VAX_NAME): This field provides the brand name of the vaccine administered in Box 13 of the VAERS form. 6. List of commonly used abbreviations used at the VAERS program Abbrev Explanation ------------------------------------------------------------------------- a/ Before abd Abdomen abn abnormal (i.e., abn behavior, abn lab values) addl Additional adm. admitted, admission ADR adverse drug reaction ADL activities of daily living AE Adverse Event afeb Afebrile AKA also known as alk phos alkaline phosphatase allerg allergy, allergic ALT serum glutamic pyruvic transaminase (also SGPT) AMA American Medical Association amb ambulance, ambulate amt Amount ANA antinuclear antibody ANAM acute motor axonal neuropathy APAP Acetaminophen approx Approximately appt Appointment ASA Aspirin assoc Associated AST serum glutamic oxaloacetic transaminase (also SGOT) ATB Antibiotics ax axillary (temperature) baso Basophils BC blood culture BID twice daily bilat Bilateral bili Bilirubin bm bowel movement BOM bilateral otitis media BP blood pressure BPM or b pm beats per minute BUN blood urea nitrogen Bx biopsy, biopsies, biopsied Ca calcium CA cancer CBC complete blood count cc chief complaint CDC Centers for Disease Control and Prevention CHD congenital heart disease CHF congestive heart failure CHN community health nurse chr chronic cm centimeter CNS central nervous system c/o complained of COD cause of death cont continued convuls convulsion COPD chronic obstructive pulmonary disease CPK creatinine phosphokinase CPR cardiopulmonary resuscitation C&S culture & sensitivity CSF cerebrospinal fluid CT/CAT computerized axial tomography (i.e., CAT scan) ctr center CXR chest X?ray D diarrhea d/c discontinued dec decreased, diminished delt deltoid devel developed diam diameter diff differential blood count disch discharge DO Doctor of Osteopathy DPH diphenhydramine (Benadryl) DT diphtheria tetanus DTox diphtheria toxoid DTP diphtheria, tetanus, pertussis vaccine dtr deep tendon reflexes Dx diagnosis ECG/EKG electrocardiogram EEG electroencephalogram elev elevate or elevated EMT emergency medical technician eos eosinophils epi epinephrine ER emergency room esp especially ESR erythrocyte sedimentation rate eval evaluation exam examination exp experienced fam family FDA Food and Drug Administration feb febrile FH family history fr from FTR father f/u follow up fx fracture GBS Guillain Barre Syndrome gen general GI gastrointestinal gm gram GR-FR grandfather GR-MO grandmother gtt drop(s) h/a headache HBP high blood pressure hct hematocrit HEENT head, eyes, ears, nose, and throat hep hepatitis hgb hemoglobin hlth health HLV herpes-like virus h/o history of hosp hospital hr hour, hours HTN hypertension husb husband hx history ICU intensive care unit ID identification, identified Ig immunoglobulin IgG immunoglobulin G IM intramuscular immed immediately immun immunization imp improved inc increase inflam. inflammation infect infection inj injection intermit intermittent IPV inactivated poliovirus vaccine ITP idiopathic thrombocytopenic purpura. IV intravenous K potassium kg kilogram L left or liter lab laboratory lb pound, pounds LDH lactic dehydrogenase LMP last menstrual period LOC level of consciousness or loss of consciousness LP lumbar puncture LPN/LVN Licensed practical or vocational nurse lt left LT Left Thigh LUA left upper arm lymphs lymphocytes lytes electrolytes (Na, K, Cl, etc) mbr member (of family) mcg microgram MD doctor, medical doctor med(s) medication(s) men meningitis MFR manufacturer mg milligram mgm alternative abbreviation for milligram min(s) minute(s) ml milliliter mm millimeter MMR measles, mumps, rubella vaccine (or individual components of M, M, or R) MN midnight mod moderate mon month, months mono monocytes, mononucleosis MTR mother n/a not applicable, not available neg negative neuro neurologic NKA no known allergies NKDA no known drug allergies nl normal # number noc night np nurse practicioner npo nothing by mouth (nil per os) NSAID(s) non-steroidal anti-inflammatory drug(s) N & V nausea and vomiting N,V, D nausea, vomiting, diarrhea O2 oxygen ofc office Om otitis media OTC over the counter (medication) oth other oz ounce, ounces P pulse p/ after PA physician's assistant PC/TC phone call or telephone call PCN Penicillin PDD Pervasive Developmental Delay PE physical exam ped pediatrician peds pediatrics PERRL pupils equal, round, reactive to light PERRLA pupils equal, round, reactive to light and accommodation PET positron-emission tomography pH hydrogen ion concentration (acidity/alkalinity) pharm. pharmacy PharmD doctor of pharmacy phenobarbphenobarbital PHN public health nurse PMD private medical doctor PN practical nurse PNP pediatric nurse practitioner PO by mouth pos positive poss possible PPD purified protein derivative pr per rectum pred prednisone prev previous PRN as needed pt(s) patient, patients PT prothrombin. time PTT partial thromboplastin time PVT private q every QID four times a day qtr quarter R respiration or right RBC red blood cell recv received, receives, receive rehab rehabilitation resp respiratory RIG rabies immune globulin RN registered nurse r/o rule out ROM range of motion rpt report or reported rt right RT Right Thigh R/T related to RTC return to clinic RUA right upper arm rx therapy; treatment; medication (i.e., pt's rx = tylenol) rxn reaction, reactions SC subcutaneous sec second, seconds sed rate sedimentation rate SG specific gravity SGOT serum glutamic oxaloacetic transaminase (also AST) SGPT serum glutamic pyravic transaminase (also ALT) SHC state health coordinator sib sibling, siblings SIDS sudden infant death syndrome sl slight, slightly SMA sequential multiple analyzer (series of blood chemistries) SOB shortness of breath S & S signs & symptoms s/sx signs & symptoms stat immediately std standard Sx symptom, symptoms, sign, signs synd syndrome sz seizure, seized, seizures T temperature (Fahrenheit) tab tablet, tablets TB tuberculosis tbsp tablespoon, tablespoons TC/PC telephone call or phone call TD adult tetanus and diphtheria toxoid temp temperature TID three times a day TOPV trivalent oral polio vaccine tox toxic, toxoid, toxicology (as in toxicology screen) TPN total parenteral nutrition TPR temperature, pulse, respiration trach tracheostomy tsp teaspoon, teaspoons Ttox tetanus toxoid TTP thrombotic thrombocytopenic purpura tx treatment, treatments, treated u units, unit ur urine UA urinalysis unk unknown URI upper respiratory infection USP United States Pharmacopeia (standard) UTI urinary tract infection V vomiting vax vaccine, vaccines v fib ventricular fibrillation VS vital signs (temperature, pulse, resp, blood pressure) VSS vital signs stable v tach ventricular tachycardia VZIG varicella zoster immune globulin w/ with w/o without w/u work up WBC white blood cell wk week, weeks WNL within normal limits wt weight x/ except yr year, years @ at & and -> causes to , resulting in, showed, to the right, progressing toward <- resulting from, to the left > greater than < less than