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This is VAERS ID 272477

Case Details

VAERS ID: 272477 (history)  
Age: 13.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-01-15
Onset:2007-01-17
   Days after vaccination:2
Submitted: 2007-02-14
   Days after onset:28
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B009AA / 0 RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1893AA / 0 LA / UN

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0701USA02867

Write-up: Information has been received from a registered nurse concerning a female patient who was vaccinated with a dose of GARDASIL concomitantly with a dose of MENACTRA and a dose of DTaP. Subsequently the patient developed knot at the injection site where she received DTaP. It was reported that the patient with a knot or "raised area" that was 1 and 1/2 inches long. At the time of the report, the patient''s outcome was unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 2/14/2007. Initial and follow-up information has been received from a registered nurse concerning a 13 year old female who on 15-JAN-2006 was vaccinated, into the left deltoid, with a first dose of GARDASIL vaccine (lot #654389/0961F) concomitantly with a first dose of MENACTRA vaccine (lot #U1893AA) in the left deltoid and first dose of BOOSTRIX (lot #AC52B009AA) into the right deltoid. There were no concomitant medications. On 17-JAN-2007, the patient developed knot at the injection site where she received BOOSTRIX. It was reported that the patient presented with redness and a knot of "raised area" that was 1 and 1/2 inches long. Follow-up reported that the patient had mild erythema (no swelling) at the injection site of GARDASIL vaccine and MENACTRA. The patient was seen in the physician''s office on 17-JAN-2007. At the time of the follow-up report, the patient''s outcome was unknown. Additional information is not expected.


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