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This is VAERS ID 277687

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 277687
VAERS Form:
Age:11.0
Gender:Female
Location:Minnesota
Vaccinated:2007-04-23
Onset:2007-04-25
Submitted:2007-04-26
Entered:2007-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 03874 / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014BA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 03054 / - LA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema, Pruritus, Skin warm, Swelling, Tenderness

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

Write-up: large area of erythema 4x4 cm central with 8-10 cm larger halo erythema with clearing between, very tender to touch, warm, mildly swollen-pruritic after varicella/2 days after shot


Changed on 12/8/2009

VAERS ID: 277687 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Minnesota
Vaccinated:2007-04-23
Onset:2007-04-25
Submitted:2007-04-26
Entered:2007-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 03874 / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014BA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 03054 / - LA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Erythema, Pruritus, Skin warm, Swelling, Tenderness

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

Write-up: large area of erythema 4x4 cm central with 8-10 cm larger halo erythema with clearing between, very tender to touch, warm, mildly swollen-pruritic after varicella/2 days after shot


Changed on 9/14/2017

VAERS ID: 277687 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Minnesota
Vaccinated:2007-04-23
Onset:2007-04-25
Submitted:2007-04-26
Entered:2007-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 03874 / 0 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014BA / 0 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 03054 / - UNK LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pruritus, Skin warm, Swelling, Tenderness

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

Write-up: large area of erythema 4x4 cm central with 8-10 cm larger halo erythema with clearing between, very tender to touch, warm, mildly swollen-pruritic after varicella/2 days after shot


Changed on 2/14/2018

VAERS ID: 277687 Before After
VAERS Form:1
Age:11.0
Gender:Female
Location:Minnesota
Vaccinated:2007-04-23
Onset:2007-04-25
Submitted:2007-04-26
Entered:2007-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 03874 / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014BA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 03054 / UNK LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pruritus, Skin warm, Swelling, Tenderness

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

Write-up: large area of erythema 4x4 cm central with 8-10 cm larger halo erythema with clearing between, very tender to touch, warm, mildly swollen-pruritic after varicella/2 days after shot


Changed on 6/14/2018

VAERS ID: 277687 Before After
VAERS Form:1
Age:11.0
Gender:Female
Location:Minnesota
Vaccinated:2007-04-23
Onset:2007-04-25
Submitted:2007-04-26
Entered:2007-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 03874 / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014BA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 03054 / UNK LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Pruritus, Skin warm, Swelling, Tenderness

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

Write-up: large area of erythema 4x4 cm central with 8-10 cm larger halo erythema with clearing between, very tender to touch, warm, mildly swollen-pruritic after varicella/2 days after shot

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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=277687&WAYBACKHISTORY=ON


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