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This is VAERS ID 263211

Case Details

VAERS ID: 263211 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Florida  
Vaccinated:2006-08-11
Onset:2006-08-12
   Days after vaccination:1
Submitted: 2006-09-14
   Days after onset:33
Entered: 2006-09-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Pain
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: (therapy unspecified)
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0608USA03973

Write-up: Initial and follow up has been received from a healthcare worker in a physician''s office concerning her 19 year old daughter who was a student and an unspecified person at the physician''s office. On 11-AUG-2006, at 11:15 am, the patient was vaccinated intramuscularly in the deltoid with the first dose of HPV rLi 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0702F). Other concomitant therapy included an unspecified therapy (''LO-L"). On 12-AUG-2006 (previously reported as 14-AUG-2006) the patient developed pain in her right arm and ribcage on the same side where the vaccine was administered. On 16-AUG-2006, the patient had recovered from the events. No further information is available.


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