It is the first report of injuries associated with the month-old civilian vaccination program. The three people, whom officials would not identify, live in Florida and are doing well.

As of last week, 7,354 people had been vaccinated in 38 states and Los Angeles and New York, which are running separate programs.

Based on data collected in the 1960s, before routine smallpox vaccinations ended in the United States, as many as 50 people out of every 1 million being vaccinated for the first time suffer life-threatening complications, and one or two die.

The Centers for Disease Control and Prevention requires that states look for serious reactions to the vaccine. Health problems that do not have any obvious relation to the vaccination also are being reported so authorities can investigate.

"Our surveillance system is very good. It's working," Dr. Eric Mast, a CDC immunization expert, said Thursday.

The first case reported Thursday involves a 39-year-old nurse who appears to have a rash called generalized vaccinia. The smallpox vaccine is made with a live virus called vaccinia, which can escape the inoculation site and cause infection. Generalized vaccinia can occur if someone touches the spot of the vaccination and then another part of the body.

The nurse in this case reported pain, malaise and headache nine days after receiving the vaccine. The next day, she developed a rash on her chest that spread onto her back and included scattered pustules, which are typical of generalized vaccinia.

She was treated with antihistamines and within a few days, the rash began fading. It was not expected to leave a permanent scar. Testing was under way to confirm if she had generalized vaccinia.

The second case involves a 60-year-old man who already had symptoms of heart disease before being inoculated. He had chest pains while playing tennis four days after getting the vaccine, was diagnosed with a blocked coronary artery and had angioplasty. The smallpox vaccine has never been associated with heart problems such as angina.

The third case, reported by Florida authorities but not by the CDC, involves a vaccine recipient whose gallbladder was removed because of an acute inflammation. Gallbladder problems also are not associated with the vaccine.

CDC officials plan a survey of 10,000 people vaccinated to measure less severe reactions to the vaccine.

State and federal officials initially had expected to vaccinate as many as 450,000 people to serve on smallpox response teams, which would investigate suspicious cases and care for infected patients. So far the numbers are considerably lower amid skepticism about the need for the vaccinations and unresolved questions about the inoculation program.

In the military, where more than 100,000 people have been vaccinated, there have been five serious reactions. All five men are in good condition, officials said.

Two had encephalitis, one had a heart infection, one developed generalized vaccinia rash and one may have had "ocular vaccinia," where the virus used in the vaccine migrates to the eye. In most cases, the symptoms were not severe.

Routine smallpox vaccinations ended in the United States in 1972, as smallpox was on the wane. No one has contracted the disease in this country since 1949, and the last naturally occurring case anywhere was in 1977.

Experts fear the virus could return in an act of bioterrorism, and President Bush started the new vaccination program in December.

For More Information:

www.smallpox.gov