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This is VAERS ID 269209

Case Details

VAERS ID: 269209 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Washington  
Vaccinated:2006-11-13
Onset:2006-11-13
   Days after vaccination:0
Submitted: 2006-12-14
   Days after onset:31
Entered: 2006-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Pain, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (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: NONE
Current Illness:
Preexisting Conditions: Pencillin allergy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0611USA05100

Write-up: Information has been received from a registered nurse at an OB/GYN''s office concerning a 14 year old female with penicillin allergy who on 13 Nov 2006 was vaccinated intramuscularly in the left deltoid with Gardasil (yeast) (lot #653938/0954F). There was no concomitant medication. On 13 Nov 2006 the patient experienced pain in the vaccinated arm, headache, dizziness, fatigue, weakness and ringing in the ears. The patient sought treatment from her pediatrician. At the time of this report the patient''s pain in the arm, headache, dizziness, fatigue, weakness and ringing in the ears persisted. Additional information has been requested.


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