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This is VAERS ID 276827

Case Details

VAERS ID: 276827 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: California  
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:170
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Chills, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA03749

Write-up: Information has been received from a physician, via a company representative, concerning a patient who was vaccinated with a dose of Gardasil (date not specified). On 25-OCT-2006 the patient developed "a temperature elevation of 102 degrees." Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/13/2007. Initial and follow up information has been received from a physician, concerning an 11 year old female patient, who on 25-OCT-2006, was vaccinated in teh afternoon (exact time not specified), in the left arm with the firs dose of GARDASIL (Lot #651650/0702F). The physician confirmed that the patient''s physical exam at the visit "revealed no sign of illness." By 9:00 pm that evening, the patient had developed a temperature or 102.5F, and a swollen left arm. On 26-OCT-2006, the next day, the patient''s temperature further elevated to 103 degrees, and she experienced chills. the physician reported that the patient recovered from the swollen arm, fever and chills on 28-OCT-2006, within 72 hours of the vaccination. No further information is expected.

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