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This is VAERS ID 276830

Case Details

VAERS ID: 276830 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Maryland  
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:30
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Eye pain, Headache, Malaise
SMQs:, Glaucoma (broad)

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Physical examination 03/16/07 - normal
CDC Split Type: WAES0703USA03793

Write-up: Information has been received from a physician concerning a 11 year old female patient with chronic seasonal allergies, allergic rhinitis, obesity and possible attention deficit disorder who on 14-MAR-2007, at 5:00 PM was vaccinated IM with a dose of Gardasil. lot # 655849/0263U. Later that day she developed a headache between her eyes and malaise. In folllow up it was reported that on 14-MAR-2007 patient developed headaches, eye pain and mild malaise at 6:00 PM. On 15-MAR-2007 patient had a physical examination which was normal. Her symptoms completely resolved within a few days. On 16-MAR-2007 patient recoverd. Addititional information is not expected.

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