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This is VAERS ID 264783

Case Details

VAERS ID: 264783 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2006-09-19
Onset:2006-09-19
   Days after vaccination:0
Submitted: 2007-01-05
   Days after onset:108
Entered: 2006-10-17
   Days after submission:80
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 1 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2559 / 1 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: UNK
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: body temp 09/19/06 101 -
CDC Split Type: WAES0610USA01164

Write-up: Information has been received from a physician concerning an 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Additional information has been requested. This is in follow-up to report (s) previously submitted on 10/13/2006. Information has been received from a physician concerning a 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of GARDASIL. Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Follow up information has been received regarding the 11 year old white female with no medical history who at 2:30 p.m. on 19-SEP-2006 was vaccinated in the right arm with her first dose of GARDASIL, lot #653735/0688F. She received her first dose of ADACEL in the left arm at the same time. At 7:00 p.m. on the same day, she developed a headache. She woke up during the night with severe headache. Fever was approximately 101-102. On the afternoon of 20-SEP-2006 she was better and able to attend school. It was reported that she recovered from headache and fever on the afternoon of 20-SEP-2006. Additional information is not expected. This is a consolidation of two reportes concerning the same patient. WAES #0160USA00860 was previously submitted on 13-OCT-2006.


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