VAERS ID: |
274437 (history) |
Form: |
Version 1.0 |
Age: |
9.0 |
Gender: |
Female |
Location: |
Nevada |
Vaccinated: | 2007-03-21 |
Onset: | 2007-03-21 |
Days after vaccination: | 0 |
Submitted: |
2007-03-21 |
Days after onset: | 0 |
Entered: |
2007-03-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / 1 |
RA / - |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
- / 2 |
LA / - |
Administered by: Private Purchased by: Private Symptoms: Dizziness,
Nausea,
Pallor,
Vomiting SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: none~ ()~NULL~~In Patient|none~ ()~NULL~~In Sibling1|none~ ()~NULL~~In Sibling2 Other Medications: Current Illness: none Preexisting Conditions: none Allergies: Diagnostic Lab Data: none CDC Split Type:
Write-up: Approximately 5 minutes after administration my child complained of nausea and dizziness, she appeared pale. About 10 min later she vomitted. About 15 min after administration she felt ok. |