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This is VAERS ID 284005

Case Details

VAERS ID: 284005 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: California  
Vaccinated:2007-06-27
Onset:2007-06-28
   Days after vaccination:1
Submitted: 2007-06-29
   Days after onset:1
Entered: 2007-07-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0469U / UNK RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2731AA / UNK LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0644U / UNK LA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site pruritus, Injection site swelling
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt states she noticed arm swelling (L) arm 6/28/07 in the evening w/slight itching


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