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This is VAERS ID 276336

Case Details

VAERS ID: 276336 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2007-03-12
Onset:2007-03-19
   Days after vaccination:7
Submitted: 2007-05-12
   Days after onset:54
Entered: 2007-04-16
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1497F / 2 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Rash papular, Rash pruritic, Rash vesicular
SMQs:, Anaphylactic reaction (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Papular vesicular pruritic rash began 1 week after receiving Varivax booster.


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