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This is VAERS ID 267438

Case Details

VAERS ID: 267438 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Unknown  
Vaccinated:2006-10-09
Onset:2006-10-16
   Days after vaccination:7
Submitted: 2006-11-14
   Days after onset:29
Entered: 2006-11-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site mass, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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: (therapy unspecified)
Current Illness:
Preexisting Conditions: CONCURRENT CONDITIONS: Hypertension; General symptom
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0610USA10767

Write-up: Information has been received from a health professional concerning a 22 year old female with hypertension and "an interstitial problem" NOS who on 09-Oct-2006 was vaccinated intramuscularly with HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot# not provided). Concomitant therapy included unspecified therapy. On 16-Oct-2006 the patient developed a "quarter size knot at the injection site that was warm to touch". Medical attention was sought and the patient was treated with diphenhydramine hydrochloride (BENADRYL). It was reported that the patient will discontinue the vaccination series. At the time of this report the patient had not recovered from the event. Additional information has been requested.


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