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This is VAERS ID 261579

Case Details

VAERS ID: 261579 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Texas  
Vaccinated:2006-07-28
Onset:2006-07-28
   Days after vaccination:0
Submitted: 2006-08-10
   Days after onset:13
Entered: 2006-08-15
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Injection site pain
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: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0608USA00186

Write-up: Information has been received from a physician concerning a 14 year old female who on 28-JUL-2006 was vaccinated with HPV rLI 3 11 16 18 VLP vaccine (yeast). Concomitant vaccination on 28-JUL-2006 included diphtheria toxoid (+) pertussis vaccine (unspecified) (+) tetanus toxoid. The patient stated that following vaccination on 28-JUL-2006, she " experienced a great deal of pain at the injection site". Unspecified medical attention was sought. At the time of this report, the outcome of the event was unknown. Additional information has been requested.


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