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This is VAERS ID 271014

Case Details

VAERS ID: 271014 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: California  
Vaccinated:2007-01-16
Onset:2007-01-17
   Days after vaccination:1
Submitted: 2007-01-18
   Days after onset:1
Entered: 2007-01-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / UNK LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2082AA / UNK LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1154F / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Injection site erythema, Injection site oedema, Injection site pain
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Pain, redness, swelling on (L) upper arm, feels weak no fever.


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