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This is VAERS ID 263222

Case Details

VAERS ID: 263222 (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 UN / 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: WAES0609USA00391

Write-up: Information has been received from a registered nurse concerning a female patient who in 2006 was vaccinated with her first dose of GARDASIL. Subsequently, she was vaccinated with her second dose of GARDASIL (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 information indicated that the patient was being treated with an unspecified vaccine, and not GARDASIL as previously reported. Therefore, WAES #0609USA00391 is being deleted from our files on GARDASIL. This report was previously sent to PLA V501 on 14-SEP-2006.


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