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This is VAERS ID 282710

Case Details

VAERS ID: 282710 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Female  
Location: California  
Vaccinated:2007-06-19
Onset:2007-06-19
   Days after vaccination:0
Submitted: 2007-06-21
   Days after onset:2
Entered: 2007-06-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B009AA / UNK LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 LA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1250F / UNK LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness, heat and mild swelling to left upper arm at injection site. Denies pain.


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