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This is VAERS ID 269171

Case Details

VAERS ID: 269171 (history)  
Form: Version 1.0  
Gender: Female  
Location: Indiana  
   Days after vaccination:1
Submitted: 2006-12-14
   Days after onset:41
Entered: 2006-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad), 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:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES0611USA01551

Write-up: Information has been received from a physician concerning a female who on an unspecified date received the first dose of Gardasil (yeast) (Lot # not provided). On 02 Nov 2006 the patient was vaccinated with the second dose of Gardasil (yeast) (Lot # not provided). On 03 Nov 2006 the patient experienced joint pain and developed a rash. Unspecified medical attention was sought. At the time of this report the patient was recovering from the event. Additional information has been requested.

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