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This is VAERS ID 281386

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

281386
VAERS Form:
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-05-07
Onset:2007-05-07
Submitted:2007-05-10
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1281F / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U1239AA / 0 LA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2454AA / 5 RA / -

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain upper, Headache, Injection site induration, Blood test normal, Injected limb mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None per mom and Patient
Preexisting Conditions: Denied allergies
Allergies:
Diagnostic Lab Data: per moms description: Blood work to check for infection. Results reported as within normal limits.
CDC 'Split Type':

Write-up:5/10/07 0830 in ER with swollen, hot hard rt deltoid with c/o excessive pain and unwillingness to use arm. Pain rated 8 on 1-10. Blood drawn. no infection noted. Warm packs and NSAID. 5/1107 0900 back in ER. /"Twice as big/" /"hard/", /"head hurts/", /"st"omach hurts/", per mother. Augmentin and Hydrazine given. Approx 12/" x 8/" per mom. 5/14/07 called mom. Went to another ER, was prescribed steroids per mom, all better. Will follow up 5/18


Changed on 12/8/2009

281386 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-05-07
Onset:2007-05-07
Submitted:2007-05-10
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1281F / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U1239AA / 0 LA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2454AA / 5 RA / -

Administered by: Other      Purchased by: Unknown Private
Symptoms: Abdominal pain upper, Headache, Injection site induration, Injection site warmth, Pain, Blood test normal, Injection site swelling, Injected limb mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None per mom and Patient
Preexisting Conditions: Denied allergies
Allergies:
Diagnostic Lab Data: per moms description: Blood work to check for infection. Results reported as within normal limits.
CDC 'Split Type':

Write-up:5/10/07 0830 in ER with swollen, hot hard rt deltoid with c/o excessive pain and unwillingness to use arm. Pain rated 8 on 1-10. Blood drawn. no infection noted. Warm packs and NSAID. 5/1107 0900 back in ER. /"Twice "Twice as big/" /"hard/", /"head hurts/", /"st"omach hurts/", big" "hard", "head hurts", "stomach hurts", per mother. Augmentin and Hydrazine given. Approx 12/" 12" x 8/" 8" per mom. 5/14/07 called mom. Went to another ER, was prescribed steroids per mom, all better. Will follow up 5/18


Changed on 4/7/2010

281386 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-05-07
Onset:2007-05-07
Submitted:2007-05-10
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1281F / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1239AA / 0 LA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2454AA / 5 RA / -

Administered by: Other      Purchased by: Private
Symptoms: Abdominal pain upper, Headache, Injection site induration, Injection site warmth, Pain, Blood test normal, Injection site swelling, Injected limb mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None per mom and Patient
Preexisting Conditions: Denied allergies
Allergies:
Diagnostic Lab Data: per moms description: Blood work to check for infection. Results reported as within normal limits.
CDC 'Split Type':

Write-up:5/10/07 0830 in ER with swollen, hot hard rt deltoid with c/o excessive pain and unwillingness to use arm. Pain rated 8 on 1-10. Blood drawn. no infection noted. Warm packs and NSAID. 5/1107 0900 back in ER. "Twice as big" "hard", "head hurts", "stomach hurts", per mother. Augmentin and Hydrazine given. Approx 12" x 8" per mom. 5/14/07 called mom. Went to another ER, was prescribed steroids per mom, all better. Will follow up 5/18


Changed on 9/14/2017

281386 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-05-07
Onset:2007-05-07
Submitted:2007-05-10
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1281F / 0 1 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1239AA / 0 1 LA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2454AA / 5 6 RA / -

Administered by: Other      Purchased by: Private
Symptoms: Abdominal pain upper, Headache, Injection site induration, Injection site warmth, Pain, Blood test normal, Injection site swelling, Injected limb mobility decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None per mom and Patient
Preexisting Conditions: Denied allergies
Allergies:
Diagnostic Lab Data: per moms description: Blood work to check for infection. Results reported as within normal limits.
CDC 'Split Type':

Write-up:5/10/07 0830 in ER with swollen, hot hard rt deltoid with c/o excessive pain and unwillingness to use arm. Pain rated 8 on 1-10. Blood drawn. no infection noted. Warm packs and NSAID. 5/1107 0900 back in ER. "Twice as big" "hard", "head hurts", "stomach hurts", per mother. Augmentin and Hydrazine given. Approx 12" x 8" per mom. 5/14/07 called mom. Went to another ER, was prescribed steroids per mom, all better. Will follow up 5/18


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