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This is VAERS ID 284005

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

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

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site pruritus, Injection site swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) 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


Changed on 9/14/2017

284005 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:California
Vaccinated:2007-06-27
Onset:2007-06-28
Submitted:2007-06-29
Entered:2007-07-06
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) 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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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284005&WAYBACKHISTORY=ON


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