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This is VAERS ID 264066

Case Details

VAERS ID: 264066 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2006-09-25
Onset:2006-09-25
   Days after vaccination:0
Submitted: 2006-10-03
   Days after onset:8
Entered: 2006-10-06
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2108AA / 1 RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2556AA / 1 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Injection site induration, Injection site reaction, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 2 separate reactions Tdap 6x4 1/2" area hot to touch. Induration of biceps upper arm started day of injection given seen in office 9/28/06, Gardasil 3 1/2 x 3" hot to touch started 3 days after shot for both ice and Ibuprophen.


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