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This is VAERS ID 260308

Case Details

VAERS ID: 260308 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2006-06-20
Onset:2006-06-28
   Days after vaccination:8
Submitted: 2006-07-16
   Days after onset:18
Entered: 2006-07-26
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 006BA / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed Idiopathic thrombocytopenic purpura.


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