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This is VAERS ID 267432

Case Details

VAERS ID: 267432 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: California  
Vaccinated:2006-10-11
Onset:2006-10-11
   Days after vaccination:0
Submitted: 2006-11-14
   Days after onset:34
Entered: 2006-11-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Hypoaesthesia, Injection site reaction
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions: Asthma, drug Hypersensitivity.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0610USA09277

Write-up: Information has been received from a physician concerning a 12 year old female with asthma and Advair allergy who on 10/11/06 was vaccinated with HVP vaccine. Concomitant therapy that day included varicella virus vaccine and influenza vaccine. On 10/11/06 the pt experienced numbing at injection site and around arm. The pt recovered. Unspecified medical attention was sought. Additional information has been requested.


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