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This is VAERS ID 423293

(NOTE: This result is from the 6/11/2011 version of the VAERS database)

Case Details

VAERS ID: 423293 (history)  
Form: Version .0  
Age: 12.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-07-03
Onset:2011-01-11
   Days after vaccination:1288
Submitted: 2011-05-12
   Days after onset:120
Entered: 2011-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 UN / SC

Administered by: Private       Purchased by: Private
Symptoms: Herpes zoster
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1101USA03560

Write-up: Information has been received from a registered pharmacist concerning her 12 year old daughter who on an unspecified date was vaccinated with the second dose of VARIVAX (Merck) (Lot # and expire date not reported), 0.5 ml, subcutaneously. Registered pharmacist stated that on an unspecified date, her daughter experienced shingles and added that her daughter''s shingles cleared up after she was administered acyclovir. The patient sought unspecified medical attention. Follow-up information was received from a physician concerning a female patient with no illness at the time of vaccination who on 03-JUL-2007 was vaccinated with the second dose of VARIVAX (Merck) (Lot # and expire date not reported), 0.5 ml, subcutaneously. Suspect therapy included the second dose of GARDASIL (Lot # and expire date not reported) administered on 27-JUL-2010. Concomitant therapy included the third dose of FLUVIRIN (Lot # and expire date not reported) administered on 22-AUG-2010. The physician stated that on 11-JAN-2011, the patient was diagnosed with shingles/Zoster. In 2011, the patient recovered. There were no laboratory diagnostics studies performed. The patient did not seek medical attention. Additional information is not expected.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110611&IDNUMBER=423293


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