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This is VAERS ID 271016

Case Details

VAERS ID: 271016 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-01-17
Onset:2007-01-17
   Days after vaccination:0
Submitted: 2007-01-17
   Days after onset:0
Entered: 2007-01-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Dizziness, Flank pain, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt C/O severe L flank pain with nausea, dizziness 10 min after receiving vaccine.


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