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This is VAERS ID 269172

Case Details

VAERS ID: 269172 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: North Dakota  
Vaccinated:2006-11-01
Onset:2006-11-02
   Days after vaccination:1
Submitted: 2007-04-06
   Days after onset:154
Entered: 2006-12-18
   Days after submission:108
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0640F / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Joint swelling, Pain, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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: DEPO-PROVERA
Current Illness: Hypersensitivity
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0611USA01557

Write-up: Information has been received from a physician concerning a 14 year old female who on 01-Nov-2006 was vaccinated with 0.5 ml of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0640F). At the same time, the patient received medroxyprogesterone acetate (DEPO-PROVERA) " in glut". On 01-Nov-2006 (conflicting information also reported as 02-Nov-2006), the patient developed body aches. On 03-Nov-2006 the patient developed hives all over body and also experienced ankle swelling. The patient sought unspecified medical attention. At the time of this report, the outcome of the events were unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Initial and follow up information has been received from a physician and a registered nurse concerning a 14 year old female student with an unspecified allery reported as "unknown antibiotic". On 01-NOV-2006, at 4:00 PM, the patient was vaccinated intramuscularly in the left arm with the first 0.5 mL dose of GARDASIL (Lot #653650/0640F). At that same time, the patient received DEPO-PROVERA "in glut". On 02-NOV-2006, the patient developed body aches, swollen ankles and itchy hives on stomach and arms (previously reported as hives all over body). The patient followed up with the physician. At the time of this report, the outcome of the events were unknown. Additional information has been requested.


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