National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 356422

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 356422 (history)  
Form: Version .0  
Age: 18.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:19
Submitted: 2009-09-02
   Days after onset:164
Entered: 2009-09-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Activities of daily living impaired, Arthralgia, Blood test normal, Hypersensitivity, Mechanical urticaria, Serum sickness, White blood cell count increased
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control Pills
Current Illness: Focal seizures
Preexisting Conditions: Acne
Diagnostic Lab Data:
CDC Split Type: 200903660

Write-up: This case was received from a health care professional, via another manufacturer (reference number WAES 0906USA00846), on 25 August 2009. The following is verbatim from that report: "Initial and follow-up information has been received from a nurse practitioner concerning her daughter, a 18 year old female student who on 06-MAR-2009 was vaccinated with her first dose of GARDASIL, 0.5 ml, intramuscularly into her right deltoid (LOT# 661703/0651X) at 10:40 am." "On 03-MAR-2009, the patient was vaccinated with her third dose of VARIVAX (Lot: 659845/0270X) intramuscularly into her right deltoid at 15:00 pm and with her first dose of MENACTRA (lot # U2669AA) intramuscularly into her left deltoid at 15:00 pm. Concomitant therapy included an unspecified birth control pill." "Subsequently the patient had an "allergic reaction, where you could write on her skin with a pen and still see it 3 hours later". However it was not specified if she meant that she could still saw ink on her skin 3 hours later or if she could still saw the indentation on her skin 3 hours later. The reporter''s daughter also experienced joint pain. The nurse practitioner said that her daughter''s allergist thought that it was an allergic reaction to MENACTRA (manufacturer unspecified). At the time of reporting the patient''s present status was unknown." "Additional information has been received from the medical assistant and provided the following additional details:" "The patient has a past medical history of acne, no known drug allergies." "The exact AE onset date is unknown, but the chart notes show an ER visit on approximately 22-MAR-2009. The patient went into the office on 23-MAR-2009 for blood work (values mostly within normal limits; WBC slightly elevated). The patient was treated with a MEDROL dose pack and BENADRYL. The medical assistant couldn''t say if the events were disabling or life threatening. The patient''s status was unknown." "The health care professional contacted during telephone follow up could not supply the following information: d

New Search

Link To This Search Result:

Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166