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This is VAERS ID 278170

Case Details

VAERS ID: 278170 (history)  
Form: Version 1.0  
Age:   
Gender: Unknown  
Location: Michigan  
Vaccinated:2007-04-18
Onset:2007-04-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2007-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2138AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / 6 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0117U / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: None
CDC Split Type:

Write-up: On 4-18-07 Patient received 4 shots from our office around 1600. 24 hours later red tender warm area back part of left arm where Varicella was give SQ used ice, Ibuprofen, Benadryl - By 4-22-07 area increase 3" around red, raised, tender- warm to tender, warm to touch - continued comfort treatment - by 4-23-07 4 pm red edematous reactions gone but tender to touch.


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