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This is VAERS ID 276829

Case Details

VAERS ID: 276829 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: California  
Vaccinated:2007-03-15
Onset:2007-03-19
   Days after vaccination:4
Submitted: 2007-04-13
   Days after onset:25
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Menorrhagia, Tuberculin test
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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: Unknown
Allergies:
Diagnostic Lab Data: Unk Tuberculin purified protein derivative
CDC Split Type: WAES0703USA03790

Write-up: Initial and follow up information has been received from a physician and a health care professional concerning a 13 year old female patient who on 15-MAR-2007 at 04:30 PM was vaccinated IM with a first dose of GARDASIL vaccine, lot #654510/0962F. Concomitant therapy included ADACEL, MENACTRA and tuberculin purified protein derivative. On 19-MAR-2007 the patient developed an off cycle additional menstrual cycle with a heavy flow. Unspecified medical attention was sought. The patient''s outcome was unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/13/2007. Additional information has been requested.


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