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This is VAERS ID 283996

Case Details

VAERS ID: 283996 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Texas  
Vaccinated:2007-06-19
Onset:2007-06-19
   Days after vaccination:0
Submitted: 2007-06-20
   Days after onset:1
Entered: 2007-07-06
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB37AAE / 4 - / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 2 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0099U / 3 - / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2171AA / 2 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2638AA / 1 - / IM

Administered by: Public       Purchased by: Other
Symptoms: No adverse effect, Wrong drug administered
SMQs:, Medication errors (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: No evidence of side effects, HPV vaccine given


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