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This is VAERS ID 309086

Case Details

VAERS ID: 309086 (history)  
Age: 17.0  
Gender: Female  
Location: Illinois  
Vaccinated:2007-12-05
Onset:2007-12-06
   Days after vaccination:1
Submitted: 2008-04-08
   Days after onset:123
Entered: 2008-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 15522U / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: denies
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm sore with a red bumpy rash that extended down the arm. Patient states that rash lasted for one month. Did not call our office to report adverse reaction. Immunization administered was Gardasil #2.


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