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This is VAERS ID 276831

Case Details

VAERS ID: 276831 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: California  
Vaccinated:2007-01-08
Onset:2007-01-08
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:94
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 1 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Headache, Muscle spasms, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unk
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC Split Type: WAES0703USA03856

Write-up: Information has been received from a health care professional concerning a 15 year old female patient who on 08-JAN-2007 was vaccinated in her right arm with a first dose of Gardasil, lot #654389/0961F. Subsequently the patient developed nausea, headache, dizziness, cramping and soreness. The patient''s outcome was unknown. Additional information is not expected.


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