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This is VAERS ID 282239

Case Details

VAERS ID: 282239 (history)  
Age: 17.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-05-29
Onset:2007-05-30
   Days after vaccination:1
Submitted: 2007-06-05
   Days after onset:6
Entered: 2007-06-19
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U12135AA / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blister, Herpes zoster, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccines given 5/29/07 and "blistering" rash appeared on L back and L abdomen on 5/30/07. Exam consistent with Herpes Zoster


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