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| VAERS ID: | 261359 | Vaccinated: | 2006-07-13 | | Age: | 11.0 | Onset: | 0000-00-00 | | Gender: | Female | Submitted: | 2006-07-14 | | Location: | California | Entered: | 2006-08-10, Days after submission: 27 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: NONE | | Preexisting Conditions: NONE | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | 0702F | 0 | | LA | | MEN | UNKNOWN MANUFACTURER | U1920AA | 0 | | LA | | TD | UNKNOWN MANUFACTURER | C2457AA | 5 | | RA | |
| Administered by: Private Purchased by: Private | | Symptoms: Dizziness, Lymphadenopathy, Nausea | | Write-up: Dizzy, nauseated, developed axillary lymphadenopathy on side with Menactra inoculation. |
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