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This is VAERS ID 267429

Case Details

VAERS ID: 267429 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Florida  
Vaccinated:2006-10-05
Onset:2006-10-05
   Days after vaccination:0
Submitted: 2006-11-14
   Days after onset:40
Entered: 2006-11-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Fatigue, Hypoaesthesia, Injection site erythema, Injection site hypersensitivity, Injection site mass, Malaise, Pruritus, Pyrexia, Thermal burn
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: UNK
Current Illness: Latex allergy; Drug hypersensitivity; Iodine allergy
Preexisting Conditions: Vaccination adverse reaction
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0610USA08337

Write-up: Information has been received from a physician and a 22 year old white female certified medical assistant with latex allergy, drug hypersensitivity to pertussis and iodine allergy and a history of unspecified adverse reaction after first dose of diphtheria toxoid (+) pertussis vaccine (unspecified) (+) tetanus toxoid (at less than 1 year of age. On 05-OCT-2006, at 4:00 PM,. the patient was vaccinated, into the right arm, with a first dose of HPV (lot # 653978/0955F). On 05-OCT-2006, at 4:00 PM, the patient experienced burning "as if the arm was cut with razor blade and alcohol was poured on cut," and it "hurt really bad." The patient also developed dizziness, numbness in her lower arm, fever, fatigue, and malaise. She reported that her arm swelled up 2 times the normal size and was red. She developed a dime size lump and redness at the injection site that was itchy when touched or pressed on. Unspecified medical attention was sought. At the time of the report, the dime size lump, redness and itching at the injection site persisted. No further information is available.


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