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This is VAERS ID 279264

Case Details

VAERS ID: 279264 (history)  
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 / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2228AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0367U / 1 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: ADD combined type
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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