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This is VAERS ID 273415

Case Details

VAERS ID: 273415 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Colorado  
Vaccinated:2006-11-08
Onset:0000-00-00
Submitted: 2007-03-05
Entered: 2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / SANOFI PASTEUR C2609AA / 1 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2255AAA / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site pain, Injection site reaction, Pigmentation disorder
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yaz, Celexa
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received first vaccine on 11/08/2006 never reported it until 03/01/. Area where she got Gardasil injection and tender and Hypo-pigmented. Left Arm 32mm x 24 mm 11/08/2006 Right Arm 22 x 25 mm 01/08/2007


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