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This is VAERS ID 271121

Case Details

VAERS ID: 271121 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: New Hampshire  
   Days after vaccination:56
Submitted: 2007-04-06
   Days after onset:112
Entered: 2007-01-22
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Malaise

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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0612USA02748

Write-up: Information has been received from a registered nurse concerning a female (age not reported) who on an unspecified date was vaccinated with Gardasil. Subsequently, the patient developed an "adverse reaction". No details were given of the adverse experience. At the time of this report, the outcome of the event was unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 1/16/2007. Initial and follow up information has been received from a licensed practical nurse (previously reported as registered nurse) and the mother of a 15 year old female student. On 19-OCT-2006, the patient was vaccinated in the left deltoid with the first dose of GARDASIL (Lot # 653736/0689F). The mother reported that on 14-DEC-2006, her daughter had been ill since the shot. The patient sought unspecified medical attention. It was reported that the primary care physician (PCP) had advised against getting another shot. At the time of this report, the patient had recovered from the event (date unknown). Additional information has been requested.

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