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This is VAERS ID 272477

Case Details

VAERS ID: 272477 (history)  
Form: Version 1.0  
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 / 1 RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 1 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1893AA / 1 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
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
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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