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This is VAERS ID 279264

Case Details

VAERS ID: 279264 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2007-05-16
Onset:2007-05-18
   Days after vaccination:2
Submitted: 2007-05-18
   Days after onset:0
Entered: 2007-05-22
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2228AA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0367U / 2 LA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain
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:
Current Illness: None
Preexisting Conditions: ADD combined type
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: RCV''d vaccine 5/16/07. Pain at site 5/17/07 school nurse called because 2 1/2 inch red raised spot at site of vaccine. No fever, no red streaks, no purulent discharge.


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