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This is VAERS ID 264556

Case Details

VAERS ID: 264556 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Indiana  
Vaccinated:2006-10-05
Onset:2006-10-05
   Days after vaccination:0
Submitted: 2006-10-13
   Days after onset:8
Entered: 2006-10-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2239AA / 2 LA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0223F / 2 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 RA / -

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

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

Write-up: Pain in right upper arm from time of administration of vaccine and continuing 8 days.


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