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This is VAERS ID 264066

Case Details

VAERS ID: 264066 (history)  
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 / 0 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2108AA / 0 RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2556AA / 0 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
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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