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This is VAERS ID 276177

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276177
VAERS Form:
Age:12.0
Gender:Female
Location:Ohio
Vaccinated:2007-04-10
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0244U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1968AA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B011AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0113U / 1 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site erythema, Injection site induration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: AMOXIL ALLERGY
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:area of erythema and induration at site of second varicella immunization. 9 by 4 cm. no fever


Changed on 12/8/2009

276177 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Ohio
Vaccinated:2007-04-10
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0244U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1968AA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B011AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0113U / 1 RA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site erythema, Injection site induration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: AMOXIL ALLERGY
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:area of erythema and induration at site of second varicella immunization. 9 by 4 cm. no fever


Changed on 4/7/2010

276177 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Ohio
Vaccinated:2007-04-10
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0244U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1968AA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B011AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0113U / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site induration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: AMOXIL ALLERGY
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:area of erythema and induration at site of second varicella immunization. 9 by 4 cm. no fever


Changed on 5/14/2017

276177 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Ohio
Vaccinated:2007-04-10
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0244U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1968AA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B011AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0113U / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site induration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: AMOXIL ALLERGY
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:area of erythema and induration at site of second varicella immunization. 9 by 4 cm. no fever


Changed on 9/14/2017

276177 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Ohio
Vaccinated:2007-04-10
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0244U / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / 0 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B011AA / 0 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0113U / 1 2 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Injection site erythema, Injection site induration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: AMOXIL ALLERGY
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:area of erythema and induration at site of second varicella immunization. 9 by 4 cm. no fever


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