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This is VAERS ID 273740

Case Details

VAERS ID: 273740 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Colorado  
Vaccinated:2007-03-05
Onset:2007-03-05
   Days after vaccination:0
Submitted: 2007-03-07
   Days after onset:2
Entered: 2007-03-09
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB143BK / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1062F / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Injection site vesicles, Oedema peripheral, Pain in extremity, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right upper arm red, hot, swollen 18 cm x 18 cm the circumference of arm. 5 small fluid filled vesicles around injection site. Patient c/o pain in effected arm. No systemic s/s. Doctor name reported examined patient and recommended Advil for pain ice to effected area. Advised to go to E.R. if symptoms worsened or systemic involvement occurs and contact PCP.


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