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This is VAERS ID 276648

Case Details

VAERS ID: 276648 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Michigan  
   Days after vaccination:24
Submitted: 2007-04-13
   Days after onset:41
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Injection site nodule, Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (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: None
Diagnostic Lab Data: None
CDC Split Type: WAES0703USA01549

Write-up: Information has been received from a certified medical assistant (CMA) concerning a 25 year old female who on 06-DEC-2006 was vaccinated with first dose of Gardasil (lot # 653736/0868F). On 06-FEB-2007, the patient was vaccinated with second dose of Gardasil (lot # 655165/1425F) IM in the right arm. There was no concomitant medication. On approximately 02-MAR-2007, about one month after the vaccination, the patient experienced tingling and pain at the injection site (unspecified duration), and a lump of undetermined size at the injection site. The patient sought medical attention. at the time of reporting, the tingling and pain at the injection site and lump of undetermined size at the injection site persisted. No other information was available at the time of reporting. Additional information has been requested.

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