First Appeared on 12/8/2009 |
| VAERS ID: |
341769
|
Vaccinated: |
2009-03-04 |
| Age: |
22.0 |
Onset: |
2009-03-05 |
| Gender: |
Female |
Submitted: |
2009-03-12 |
| Location: |
Iowa |
Entered: |
2009-03-13 |
|
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? No |
| Previous Vaccinations: crying, red~Pertussis (no brand name)~UN~0~In Patient |
| Other Medications: Ortho Tricyclen |
| Current Illness: No |
| Preexisting Conditions: Allergy to pertussis vaccine - Born w/out spleen |
| Diagnostic Lab Data: |
| CDC 'Split Type': Allergy to pertussis vaccine - Born w/out spleen |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) |
UNKNOWN MANUFACTURER |
|
|
IM |
LA |
| PPV: PNEUMO (PNEUMOVAX) |
MERCK & CO. INC. |
1021X |
|
IM |
LA |
| TD: TD ADSORBED (NO BRAND NAME) |
SANOFI PASTEUR |
U2024AA |
|
IM |
RA |
|
| Administered by: Public
Purchased by: Unknown |
| Symptoms: Erythema, Oedema peripheral, Pain in extremity, Skin warm, Urticaria |
| Write-up: Lt arm swollen, hives (Lt arm), Lt arm red, hot swollen pain in Lt arm no fever, no problems breathing. Will given Benadryl 3-6-09 (per doctor direction) noted hives 3-5-09 in afternoon. Arm was already painful @ that time. Still has some soreness in arm 3-13-09. Takes Ibuprofen for soreness. |
|
|
Changed on 12/7/2010 |
| VAERS ID: |
341769 Before
After
|
Vaccinated: |
2009-03-04 |
| Age: |
22.0 |
Onset: |
2009-03-05 |
| Gender: |
Female |
Submitted: |
2009-03-12 |
| Location: |
Iowa |
Entered: |
2009-03-13 |
|
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? No |
Previous Vaccinations:
crying, red~Pertussis (no brand name)~UN~0~In Patient name)~UN~0.00~Patient |
| Other Medications: Ortho Tricyclen |
| Current Illness: No |
| Preexisting Conditions: Allergy to pertussis vaccine - Born w/out spleen |
| Diagnostic Lab Data: |
| CDC 'Split Type': Allergy to pertussis vaccine - Born w/out spleen |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| FLU: INFLUENZA (SEASONAL) (NO BRAND NAME)/INFLUENZA (SEASONAL) (FLUZONE) |
UNKNOWN MANUFACTURER/SANOFI PASTEUR |
/U2802AA |
|
IM |
LA |
| PPV: PNEUMO (PNEUMOVAX) |
MERCK & CO. INC. |
1021X |
|
IM |
LA |
| TD: TD ADSORBED (NO BRAND NAME) |
SANOFI PASTEUR |
U2024AA |
|
IM |
RA |
|
| Administered by: Public
Purchased by: Unknown |
| Symptoms: Erythema, Oedema peripheral, Pain in extremity, Skin warm, Urticaria |
| Write-up: Lt arm swollen, hives (Lt arm), Lt arm red, hot swollen pain in Lt arm no fever, no problems breathing. Will given Benadryl 3-6-09 (per doctor direction) noted hives 3-5-09 in afternoon. Arm was already painful @ that time. Still has some soreness in arm 3-13-09. Takes Ibuprofen for soreness. |
|
|
Changed on 12/11/2012 |
| VAERS ID: |
341769 Before
After
|
Vaccinated: |
2009-03-04 |
| Age: |
22.0 |
Onset: |
2009-03-05 |
| Gender: |
Female |
Submitted: |
2009-03-12 |
| Location: |
Iowa |
Entered: |
2009-03-13 |
|
| Life Threatening? No |
| Died? No |
| Permanent Disability? No |
| Recovered? Yes |
| ER or Doctor Visit? Yes |
| Hospitalized? No |
| Previous Vaccinations: crying, red~Pertussis (no brand name)~UN~0.00~Patient |
| Other Medications: Ortho Tricyclen |
| Current Illness: No |
| Preexisting Conditions: Allergy to pertussis vaccine - Born w/out spleen |
| Diagnostic Lab Data: |
CDC 'Split Type':
Allergy to pertussis vaccine - Born w/out spleen
(blank) |
|
| Vaccination |
Manufacturer |
Lot |
Dose |
Route |
Site |
| FLU: INFLUENZA (SEASONAL) (FLUZONE) |
SANOFI PASTEUR |
U2802AA |
|
IM |
LA |
| PPV: PNEUMO (PNEUMOVAX) |
MERCK & CO. INC. |
1021X |
|
IM |
LA |
| TD: TD ADSORBED (NO BRAND NAME) |
SANOFI PASTEUR |
U2024AA |
|
IM |
RA |
|
| Administered by: Public
Purchased by: Unknown |
| Symptoms: Erythema, Oedema peripheral, Pain in extremity, Skin warm, Urticaria |
| Write-up: Lt arm swollen, hives (Lt arm), Lt arm red, hot swollen pain in Lt arm no fever, no problems breathing. Will given Benadryl 3-6-09 (per doctor direction) noted hives 3-5-09 in afternoon. Arm was already painful @ that time. Still has some soreness in arm 3-13-09. Takes Ibuprofen for soreness. |
|
|
