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This is VAERS ID 571471

Case Details

VAERS ID: 571471 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Male  
Location: Vermont  
Vaccinated:2015-03-12
Onset:0000-00-00
Submitted: 2015-03-12
Entered: 2015-03-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K007828 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4923BA / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4689AA / UNK RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Ear infection, Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Patient with local erythema and warmth and circular patch overlying both injection sites. Currently on CEFZIL to treat ear infection. Treated with MOTRIN and antihistamine.


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