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This is VAERS ID 270253

Case Details

VAERS ID: 270253 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Ohio  
   Days after vaccination:1
Submitted: 2007-01-05
   Days after onset:101
Entered: 2007-01-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Blister, Fluid retention, Injection site erythema, Injection site oedema, Urinary bladder rupture
SMQs:, Severe cutaneous adverse reactions (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0612USA00669

Write-up: Information has been received from a nurse concerning a 17 year old female with no medical history or allergies, who on 25 Sept 2006 was vaccinated IM into the left deltoid with a first 0.5ml dose of HPV vaccine (lot 653735/0688F). There was no concomitant medication. Twenty four hours after vaccination, the patient experienced redness and swelling at the injection site and one vesicle was fluid filled and ruptured. Unspecified medical attention was sought. No diagnostic studies were performed. Subsequently, the patient recovered. The nurse stated that the physician will discontinue the therapy and will not be administering any further doses of this vaccine to this patient. No product quality complaint was involved. Additional information has been requested.

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