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This is VAERS ID 275476

Case Details

VAERS ID: 275476 (history)  
Form: Version 1.0  
Age: 23.0  
Gender: Female  
Location: Mississippi  
Vaccinated:2007-03-12
Onset:2007-03-23
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV103 / 1 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 LA / -
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020076 / 1 RA / -

Administered by: Military       Purchased by: Military
Symptoms: Abdominal pain, Back pain, Pyrexia, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1-2 wk-fever, lower back pain, lower abdominal pain. 23-MAR-broke out in small red bumps that got bigger and itched really bad.


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