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This is VAERS ID 316982

Case Details

VAERS ID: 316982 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-04-13
Onset:0000-00-00
Submitted: 2008-06-16
Entered: 2008-06-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0017U / 1 RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0388U / 1 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2225AA / 1 RA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Blood test, Fibroadenoma of breast, Surgery, Ultrasound breast
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: blood work; breast ultra sound
CDC Split Type:

Write-up: surgical removal of giant fibroidenoma from left breast. Further plastic surgery required. Tumor was 14cm by 13cm by 6cm.


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