VAERS ID: 261636

AGE: 27| SEX: M|STATE: IL (United States)

Description

Presented to ER on 7/15/06 with c/o smallpox vaccination site reaction. Area to upper L arm about the size of a silver dollar with smallpox lesions on the left upper arm. No other lesions present to the rest of the body. Temp 101. Plan: Change dressing, follow up on Monday, If rash spreads come in sooner.

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Symptoms

Injection site reaction, Pyrexia, Rash

Vaccines

VAX DATE: 07-06-2006| ONSET DATE: 07-13-2006| DAYS TO ONSET: 7
NameDose #TypeManufacturerLotRouteSite
HEP B (NO BRAND NAME) 1 HEP Unknown AHBVB268AA IM RA
SMALLPOX (DRYVAX) 1 SMALL PFIZER\WYETH 4020072 ID LA
TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) 2 TYP Unknown X0862 IM RA

RECVDATE:08-16-2006
RPT_DATE:08-16-2006
CAGE_YR:27
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:Y
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:None
V_ADMINBY:MIL
OTHER_MEDS:None
CUR_ILL:None
HISTORY:NKDA
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:1
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:MIL

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