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This is VAERS ID 283997

Case Details

VAERS ID: 283997 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-06-18
Onset:2007-06-19
   Days after vaccination:1
Submitted: 2007-06-20
   Days after onset:1
Entered: 2007-07-06
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 42208AA / 1 RA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 05U5U / UNK RA / SC

Administered by: Private       Purchased by: Other
Symptoms: Anorexia, Dizziness, Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site reaction, Muscular weakness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Dytancs, Motrin, Westcort
Current Illness: Upper respiratory infection
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: injection site RXN - 8-8.5 annular, raised erythematous lesion, painful, pruritic to R arm systemic RX - lower limb weakness, dizziness, loss of appetite, fever.


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