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This is VAERS ID 279474

Case Details

VAERS ID: 279474 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: California  
Vaccinated:2007-05-15
Onset:2007-05-17
   Days after vaccination:2
Submitted: 2007-05-18
   Days after onset:1
Entered: 2007-05-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0369U / 2 LA / SC

Administered by: Private       Purchased by: Other
Symptoms: Body temperature, Injection site erythema, Injection site induration
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: Retin-A 0.1% Topical cream
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None ordered
CDC Split Type:

Write-up: 5/15/07 Child came in for well child exam visit; receiving Varicella and HPV vaccine. 5/17/07: Doctor visit progress notes read as follows: immunization 2 days ago, HPV and Varicella. Sibling also here with similar reaction. Temp 97.2F. Physical examination: 1/2 dollar sized area of induration and erythema left arm at injection site. Adv- Benadryl, rech prn.


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