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This is VAERS ID 264788

Case Details

VAERS ID: 264788 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2006-09-27
Onset:2006-09-28
   Days after vaccination:1
Submitted: 2007-05-21
   Days after onset:235
Entered: 2006-10-17
   Days after submission:216
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 1 RA / UN

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Body temperature normal, Eye pain, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (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: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Body temp, 09/28/06, 100
CDC Split Type: WAES0610USA03615

Write-up: Information has been received from a physician concerning a 16 year old female patient who on an unspecified date was vaccinated with a dose of GARDASIL. Subsequently, the patient developed headache and fever. Her outcome was not reported. Additional information has been requested. Follow up information has been received concerning the patient with no medical history who on 27-SEP-2006 at 2:00 p.m. received her first dose of GARDASIL, lot #653735/0688F, in the right arm. On 28-SEP-2006 at 8:00 a.m. the patient developed headache and fever (approximeately 100 oral temperature). The patient complained of headache pain behind eyes that was relieved by ADVIL. It was reported that on 29-SEP-2006 she recovered. Additional information is not expected. This is a consolidation of two reports concerning the same patient. WAES # 0610USA01350 was previously submitted on 13-OCT-2006.


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