Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. There is the possibility that broad use of FLUARIX could reveal adverse reactions not observed in clinical trials.
FLUARIX has been administered to 10,317 individuals aged 18 through 64 years and 606 individuals aged 65 years and older in 4 clinical trials and to 1,698 individuals aged 3 through 17 years in 1 clinical trial. FLUARIX QUADRIVALENT has been administered to 6,006 individuals aged 6 through 35 months in 1 clinical trial.
Individuals Aged 18 Years and Older
Trial 1 (NCT00100399) was a randomized, double-blind, placebo-controlled trial that evaluated a total of 952 subjects: FLUARIX (N = 760) and placebo (N = 192). The population was aged 18 through 64 years (mean: 39.1), 54% were female and 80% were white. Solicited adverse reactions were collected for 4 days (day of vaccination and the next 3 days) (Table 2). Unsolicited events that occurred within 21 days of vaccination (Day 0 to 20) were recorded using diary cards supplemented by spontaneous reports and a medical history as reported by subjects.
Table 2. FLUARIX: Incidence of Solicited Local and Systemic Adverse Reactions within 4 Daysa of Vaccination in Adults Aged 18 through 64 Yearsb (Total Vaccinated Cohort)Total vaccinated cohort for safety included all vaccinated subjects for whom safety data were available. n = Number of subjects with diary card completed.
a Four days included day of vaccination and the subsequent 3 days.
b Trial 1: NCT00100399.
c Grade 3 pain, muscle aches, fatigue, headache, arthralgia, shivering: Defined as prevented normal activity. Grade 3 redness, swelling: Defined as >50 mm. Grade 3 fever: Defined as >102.2°F (39.0°C).
d Fever: Defined as ≥100.4°F (38.0°C). |
Adverse Reaction | FLUARIX n = 760 % | Placebo n = 192 % |
Any | Grade 3c
| Any | Grade 3c
|
Local |
Pain | 55 | 0.1 | 12 | 0 |
Redness | 18 | 0 | 10 | 0 |
Swelling | 9 | 0.1 | 6 | 0 |
Systemic |
Muscle aches | 23 | 0.4 | 12 | 0.5 |
Fatigue | 20 | 0.4 | 18 | 1 |
Headache | 19 | 0.1 | 21 | 1 |
Arthralgia | 6 | 0.1 | 6 | 0.5 |
Shivering | 3 | 0.1 | 3 | 0 |
Feverd
| 2 | 0 | 2 | 0 |
Unsolicited adverse events that occurred in ≥1% of recipients of FLUARIX and at a rate greater than placebo included upper respiratory tract infection (3.9% versus 2.6%), nasopharyngitis (2.5% versus 1.6%), nasal congestion (2.2% versus 2.1%), diarrhea (1.6% versus 0%), influenza-like illness (1.6% versus 0.5%), vomiting (1.4% versus 0%), and dysmenorrhea (1.3% versus 1.0%).
Trial 2 (NCT00197288) was a randomized, single-blind, active-controlled U.S. trial which evaluated subjects randomized to receive FLUARIX (N = 917) or FLUZONE (N = 910), a U.S.‑licensed trivalent, inactivated influenza vaccine (Sanofi Pasteur SA) stratified by age: 18 through 64 years and 65 years and older. In the overall population, 59% of subjects were female and 91% were white. Solicited adverse reactions were collected using diary cards for 4 days (day of vaccination and the next 3 days) (Table 3). Unsolicited events that occurred within 21 days of vaccination (Day 0 to 20) were recorded using diary cards.
Table 3. FLUARIX: Incidence of Solicited Local and Systemic Adverse Reactions within 4 Daysa of Vaccination in Adultsb (Total Vaccinated Cohort)Total vaccinated cohort for safety included all vaccinated subjects for whom safety data were available. n = Number of subjects with diary card completed.
a Four days included day of vaccination and the subsequent 3 days.
b Trial 2: NCT00197288. The active control was FLUZONE, a U.S.-licensed trivalent, inactivated influenza vaccine (Sanofi Pasteur Inc.).
c Grade 3 pain, muscle aches, fatigue, headache, arthralgia, shivering: Defined as prevented normal activity. Grade 3 redness, swelling: Defined as >50 mm. Grade 3 fever: Defined as >102.2°F (39.0°C).
d Fever: Defined as ≥99.5°F (37.5°C). |
| Aged 18 through 64 Years | Aged 65 Years and Older |
Adverse Reaction | FLUARIX n = 315 % | Comparator n = 314 % | FLUARIX n = 601-602 % | Comparator n = 596 % |
Any | Grade 3c
| Any | Grade 3c
| Any | Grade 3c
| Any | Grade 3c
|
Local |
Pain | 48 | 0.3 | 53 | 0.3 | 19 | 0 | 18 | 0 |
Redness | 13 | 0 | 16 | 1 | 11 | 0.2 | 13 | 0.7 |
Swelling | 9 | 0 | 11 | 2 | 6 | 0 | 9 | 0.7 |
Systemic |
Fatigue | 21 | 0.3 | 18 | 0.6 | 9 | 0.3 | 10 | 0.7 |
Headache | 20 | 0.3 | 21 | 1 | 8 | 0.3 | 8 | 0.3 |
Muscle aches | 16 | 0 | 13 | 1 | 7 | 0.3 | 7 | 0 |
Arthralgia | 9 | 0 | 9 | 0.6 | 6 | 0.5 | 5 | 0.2 |
Shivering | 3 | 0 | 5 | 0 | 2 | 0.2 | 2 | 0 |
Feverd
| 3 | 0 | 1 | 0 | 2 | 0 | 0.5 | 0 |
Unsolicited adverse events that occurred in ≥1% of all recipients of FLUARIX or the comparator influenza vaccine in the 21‑day postvaccination period included headache (2.8% versus 2.3%), back pain (1.5% versus 0.4%), pain in extremity (1.2% versus 0.7%), pharyngolaryngeal pain (1.2% versus 0.9%), cough (1.1% versus 0.9%), fatigue (1.1% versus 0.7%), nasopharyngitis (1.0% versus 1.3%), nausea (0.4% versus 1.0%), arthralgia (0.3% versus 1.0%), and injection site pruritus (0.2% versus 1.0%).
Trial 3 (NCT00363870) was a double-blind, placebo-controlled trial in subjects aged 18 through 64 years randomized (2:1) to receive FLUARIX (N = 5,103) or placebo (N = 2,549) which was conducted to evaluate the efficacy of FLUARIX. In the total population, 60% were female and 99.9% were white. In a subset (FLUARIX [N = 305] and placebo [N = 155]), unsolicited events that occurred within 21 days of vaccination (Day 0 to 20) were recorded on diary cards. The percentage of subjects reporting at least one unsolicited event was similar among the groups (24.3% for FLUARIX and 22.6% for placebo). Unsolicited adverse events that occurred in ≥1% of recipients of FLUARIX and at a rate greater than placebo included injection site pain (5.2% versus 1.3%), dysmenorrhea (1.3% versus 0.6%), and migraine (1.0% versus 0.0%).
Serious Adverse Events: In 4 clinical trials in adults (N = 10,923), there was a single case of anaphylaxis reported with FLUARIX (<0.01%).
Incidence of Adverse Events Reported in ≥1% of Subjects in Non-US Clinical Trials: The following additional adverse events have been observed in adults in 3 additional non-US clinical trials with FLUARIX. No adverse events were observed at an incidence of >10%.
General Disorders and Administration Site Conditions: Injection site ecchymosis, injection site induration, malaise.
Infections and Infestations: Rhinitis.
Musculoskeletal and Connective Tissue Disorders: Musculoskeletal pain, neck pain.
Skin and Subcutaneous Tissue Disorders: Sweating.
In a clinical trial (NCT01204671) in which 3,036 adults (18 years of age and older) received FLUARIX QUADRIVALENT, the unsolicited adverse reactions that occurred most frequently (≥ 0.1%) following administration of FLUARIX QUADRIVALENT included dizziness, injection site hematoma, injection site pruritus, and rash.
Individuals Aged 6 Months through 17 Years
Trial 4 (NCT00383123) was a single-blind, active-controlled U.S. trial which evaluated subjects aged 6 months through 17 years who received FLUARIX (N = 2,081) or FLUZONE (N = 1,173), a U.S.‑licensed trivalent, inactivated influenza vaccine (Sanofi Pasteur SA). Children aged 6 months through 8 years with no history of influenza vaccination received 2 doses approximately 28 days apart. Children aged 6 months through 8 years with a history of influenza vaccination and children aged 9 years and older received 1 dose. Children aged 6 months through 35 months received 0.25 mL of FLUARIX (not an approved dose of FLUARIX) or comparator influenza vaccine, and children aged 3 years and older received 0.5 mL of FLUARIX or comparator influenza vaccine.
Trial subjects were aged 6 months through 17 years and 49% were female; 68% were white, 18% were black, 3% were Asian, and 11% were of other racial/ethnic groups.
Solicited local and systemic adverse reactions were collected using diary cards for 4 days (day of vaccination and the next 3 days). Unsolicited adverse events that occurred within 28 days of vaccination (Day 0 to 27) after the first vaccination in all subjects and 21 days (Day 0 to 20) after the second vaccination in unprimed subjects were recorded using diary cards.
The frequencies of solicited adverse reactions for children aged 3 years through 4 years and for children aged 5 years through 17 years were similar for FLUARIX and the comparator vaccine (Table 4).
Table 4. FLUARIX: Incidence of Solicited Local and Systemic Adverse Reactions within 4 Daysa of First Vaccination in Children Aged 3 through 17 Yearsb (Total Vaccinated Cohort)Total vaccinated cohort for safety included all vaccinated subjects for whom safety data were available. n = Number of subjects with diary card completed.
a Four days included day of vaccination and the subsequent 3 days.
b Trial 4: NCT00383123. The active control was FLUZONE, a U.S.-licensed trivalent, inactivated influenza vaccine (Sanofi Pasteur Inc.).
c Grade 3 pain, irritability, loss of appetite, drowsiness, muscle aches, fatigue, headache, arthralgia, shivering: Defined as prevented normal activity. Grade 3 swelling, redness: Defined as >50 mm. Grade 3 fever: Defined as >102.2°F (39.0°C).
d Fever: Defined as ≥99.5°F (37.5°C). |
| Aged 3 through 4 Years | Aged 5 through 17 Years |
Adverse Reaction | FLUARIX n = 350 % | Comparator n = 341 % | FLUARIX n = 1,348 % | Comparator n = 451 % |
Any | Grade 3c
| Any | Grade 3c
| Any | Grade 3c
| Any | Grade 3c
|
Local |
Pain | 35 | 2 | 38 | 1 | 56 | 0.8 | 56 | 0.7 |
Redness | 23 | 0.3 | 20 | 0 | 18 | 1 | 16 | 0.7 |
Swelling | 14 | 0 | 13 | 0 | 14 | 2 | 13 | 0.7 |
Systemic |
Irritability | 21 | 0.9 | 22 | 0 | – | – | – | – |
Loss of appetite | 13 | 0.9 | 15 | 0.9 | – | – | – | – |
Drowsiness | 13 | 0.6 | 20 | 0.9 | – | – | – | – |
Feverd
| 7 | 1 | 8 | 2 | 4 | 0.3 | 3 | 0.2 |
Muscle aches | – | – | – | – | 29 | 0.4 | 29 | 0.4 |
Fatigue | – | – | – | – | 20 | 1 | 19 | 1 |
Headache | – | – | – | – | 15 | 0.5 | 16 | 0.9 |
Arthralgia | – | – | – | – | 6 | 0.1 | 6 | 0.2 |
Shivering | – | – | – | – | 3 | 0.1 | 4 | 0.2 |
In children who received a second dose of FLUARIX or the comparator vaccine, the incidences of adverse reactions following the second dose were similar to those observed after the first dose.
Unsolicited adverse events that occurred in ≥1% of recipients of FLUARIX aged 6 months through 17 years included upper respiratory tract infection (5.5%), pyrexia (4.8%), cough (4.7%), vomiting (3.2%), headache (2.8%), rhinorrhea (2.7%), diarrhea (2.5%), pharyngolaryngeal pain (2.4%), nasopharyngitis (2.3%), otitis media (2.0%), nasal congestion (1.8%), upper abdominal pain (1.4%), and upper respiratory tract congestion (1.0%). The incidences of these events were similar in recipients of the comparator vaccine.
Trial 5 (NCT01439360) was a randomized, observer-blind, non-influenza vaccine-controlled trial evaluating the efficacy of FLUARIX QUADRIVALENT. In this trial, subjects aged 6 through 35 months received FLUARIX QUADRIVALENT (n = 6,006) or a control vaccine (n = 6,012). The comparator was pneumococcal 13-valent conjugate vaccine [Diphtheria CRM197 Protein] (Wyeth Pharmaceuticals, Inc.) in children younger than 12 months, HAVRIX (Hepatitis A Vaccine) in children 12 months and older with a history of influenza vaccination, or HAVRIX (Dose 1) and a varicella vaccine (U.S. Licensed Manufactured by Merck & Co., Inc. or Non-U.S. Licensed Manufactured by GlaxoSmithKline Biologicals) (Dose 2) in those with no history of influenza vaccination. Subjects were aged 6 through 35 months, and one child aged 43 months (mean age: 22 months); 51% were male; 27% were white, 45% were Asian, and 28% were of other racial/ethnic groups. Children aged 12 months and older with no history of influenza vaccination and children younger than 12 months received 2 doses of FLUARIX QUADRIVALENT or the control vaccine approximately 28 days apart. Children aged 12 months and older with a history of influenza vaccination received one dose. Solicited local adverse reactions and systemic adverse events were collected using diary cards for 7 days (day of vaccination and the next 6 days). The incidences of solicited adverse reactions are shown in Table 5.
Table 5. FLUARIX QUADRIVALENT: Incidence of Solicited Local and Systemic Adverse Reactions within 7 Daysa after First Vaccination in Children Aged 6 through 35 Monthsb (Total Vaccinated Cohort)Total vaccinated cohort for safety included all vaccinated subjects for whom safety data were available. n = Number of subjects with diary card completed.
a Seven days included day of vaccination and the subsequent 6 days.
b Trial 5: NCT01439360.
c Children younger than 12 months: pneumococcal 13-valent conjugate vaccine [Diphtheria CRM197 Protein] (Wyeth Pharmaceuticals, Inc.).
d Children 12 months and older: HAVRIX (Hepatitis A Vaccine) for those with a history of influenza vaccination; or HAVRIX (Dose 1) and a varicella vaccine (U.S. Licensed Manufactured by Merck & Co., Inc. or Non-U.S. Licensed Manufactured by GlaxoSmithKline Biologicals) (Dose 2) for those with no history of influenza vaccination.
e Grade 3 pain: Defined as cried when limb was moved/spontaneously painful. Grade 3 swelling, redness: Defined as >50 mm. Grade 3 irritability: Defined as crying that could not be comforted/prevented normal activity. Grade 3 loss of appetite: Defined as not eating at all. Grade 3 drowsiness: Defined as prevented normal activity. Grade 3 fever: Defined as >102.2°F (39.0°C).
f Fever: Defined as ≥100.4°F (38.0°C). |
Adverse Reactions | FLUARIX QUADRIVALENT % | Non-Influenza Active Comparatorc,d
% |
Any | Grade 3e
| Any | Grade 3e
|
Local | n = 5,899 | n = 5,896 |
Pain | 17 | 0.4 | 18 | 0.5 |
Redness | 13 | 0 | 14 | 0 |
Swelling | 8 | 0 | 9 | 0 |
Systemic | n = 5,898 | n = 5,896 |
Irritability | 16 | 0.7 | 18 | 1 |
Loss of appetite | 14 | 1 | 15 | 1 |
Drowsiness | 13 | 0.7 | 14 | 0.9 |
Feverf
| 6 | 1 | 7 | 1 |
In children who received a second dose of FLUARIX QUADRIVALENT or the Non-Influenza Active Comparator vaccine, the incidences of solicited adverse reactions following the second dose were generally lower than those observed after the first dose.
Unsolicited adverse events occurring within 28 days of vaccination were reported in 44% and 45% of subjects who received FLUARIX QUADRIVALENT (n = 6,006) and the comparator vaccine (n = 6,012), respectively. Serious adverse events (SAEs) occurring during the study period (6 to 8 months) were reported in 3.6% of subjects who received FLUARIX QUADRIVALENT and in 3.3% of subjects who received the comparator vaccine.
In a clinical trial (NCT01196988) in which 915 children (3 through 17 years of age) received FLUARIX QUADRIVALENT, the related unsolicited adverse reactions that occurred most frequently (≥ 0.1%), following administration of FLUARIX QUADRIVALENT, included injection site pruritus and rash.
Concomitant Administration with Zoster Vaccine Recombinant, Adjuvanted (SHINGRIX)
In an open-label, randomized trial (NCT01954251), adults aged 50 years and older (median 63 years, range 50 to 92 years) received FLUARIX QUADRIVALENT and SHINGRIX at Month 0 and SHINGRIX at Month 2 (n = 413), or FLUARIX QUADRIVALENT at Month 0 and SHINGRIX at Months 2 and 4 (n = 415). Information about solicited local and systemic adverse reactions was collected using diary cards for 7 days (day of vaccination and the next 6 days). The rates of the solicited, systemic adverse reactions of fatigue, headache, myalgia, shivering, and fever (≥37.5oC) reported in subjects receiving FLUARIX QUADRIVALENT and SHINGRIX concomitantly were similar to those observed with SHINGRIX alone, and higher than when FLUARIX QUADRIVALENT was given alone.