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This is VAERS ID 279658

Case Details

VAERS ID: 279658 (history)  
Age: 12.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2007-04-10
Onset:2007-04-11
   Days after vaccination:1
Submitted: 2007-05-14
   Days after onset:33
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0001U / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1922AB / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / 0 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified) (therapy unspecified) (therapy unspecified) (therapy unspecified)
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA00082

Write-up: Information has been received from a company representative and a nurse concerning a 11 year old female who was vaccinated with a 0.5 ml dose of Gardasil. The patient developed a fever and missed at least one day aft school. The interval between administration of the vaccine and the onset of the fever is unknown. The nurse mentioned that the patient also received four additional injections at the same office visit. Subsequently, the patient recovered from the fever. Unspecified medical attention was sought. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Information has been received from a nurse and a physician concerning a 12 year old female who had no illness at the time of being vaccinated. On 10-APR-2007, the patient was vaccinated with a first dose of GARDASIL (lot # 656049/0187U) 0.5 ml, IM in the right upper arm. Also on 10-APR-2007, the patient was vaccinated with a first dose of ADACEL (lot # C2688AA) IM in the left upper arm; a first dose of VAQTA (MSD) (lot # 656993/0001U) IM in the right upper arm; and a first dose of MENACTRA (lot # U1922AB) IM in the left upper arm. On 11-APR-2007, at HS, the patient developed a fever for 24 hours. The patient sought medical attention. She also experienced a headache which was not resolved with MOTRIN and missed school on 12-APR-2007. On 13-APR-2007, the patient recovered. No additional information is expected.


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