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This is VAERS ID 276624

Case Details

VAERS ID: 276624 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: California  
Vaccinated:2007-03-06
Onset:2007-03-06
   Days after vaccination:0
Submitted: 2007-04-17
   Days after onset:41
Entered: 2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2082AA / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B007AA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1085F / 2 LA / SC

Administered by: Public       Purchased by: Private
Symptoms: Hypoaesthesia, Malaise, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOPENEX
Current Illness: None
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pain and numbeness in arm for 2 days after vaccine administered. Malaise and intermittant nausea since day of vaccination.


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