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This is VAERS ID 263221

Case Details

VAERS ID: 263221 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2006-09-14
Entered: 2006-09-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site vesicles
SMQs:

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0609USA00390

Write-up: Information has been received from a registered nurse concerning a female patient who in 2006 was vaccinated with her first dose of HPV rLi 6 11 16 18 VLP vaccine (yeast). Subsequently, she was vaccinated with her second dose of HPV rLi 6 11 16 18 VLP vaccine (yeast). Subsequently, she developed a blister at the injection site. Medical attention was sought. The patient''s outcome was unknown. Additional information has been requested. Follow-up informatin received 4-11-08, indicated that the patient was being treated with an unspecified vaccine, and not Gardasil as previously reported. Therefore, WAES #0609USA00390 is being deleted from our files on HPV rL1 6 11 16 8 VLP vaccine (yeast). This report was previously sent to PLA V501 on 09/14/06.


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