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This is VAERS ID 270433

Case Details

VAERS ID: 270433 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: New York  
Vaccinated:2007-01-03
Onset:2007-01-03
   Days after vaccination:0
Submitted: 2007-01-05
   Days after onset:2
Entered: 2007-01-12
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2271AA / UNK LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / UNK RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2116AA / UNK LA / -

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Skin ulcer, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms 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: Latex allergy.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left Deltoid 5cm x 3 1/2 cm circular erythematous tender and warm to touch lesion arm very tender.


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