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This is VAERS ID 274574

Case Details

VAERS ID: 274574 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Texas  
Vaccinated:2006-12-21
Onset:2006-12-21
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:82
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0689F / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug administered at inappropriate site, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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: Yasmin, Prozac
Current Illness:
Preexisting Conditions: Papanicolaou smear abnormal
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0702USA03916

Write-up: Information has been received from a Registered Nurse (R.N.) concerning a 19 year old female with a history of abnormal papanicolaou smear who on 21-DEC-2006 was vaccinated IM in left deltoid with her first dose of HPV, lot # 653736/0689F. Concomitant therapy included Yasmin and Prozac. She experienced severe pain in the arm with the first dose. This reaction was reported at the time of her second vaccination. On 21-FEB-2006 her second dose of HPV, lot # 655617/1447 was administered via gluteus. No symptoms were reported at that time. The patient was reported as recovered on an unspecified date. Additional information has been requested.


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