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This is VAERS ID 276880

Case Details

VAERS ID: 276880 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Illinois  
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:41
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Dizziness, Hot flush, Immediate post-injection reaction, Injected limb mobility decreased, Lacrimation increased, Musculoskeletal stiffness, Pain
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Arthritis (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: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA04433

Write-up: Information has been received from a registered nurse concerning an 11 year old female student who on 02-MAR-2007 at 11:50AM, was vaccinated IM into the left deltoid with a first dose of Gardasil (Lot# 654389/0961F). There was no illness at the time of vaccination. On 02-MAR-2007, immediately post injection, the patient experienced acute pain bringing her to tears. The patient complained of hot flash surrounding her face, lightheadedness and stiff arm with difficulty raising her arm due to pain. The nurse indicated that the symptoms subsided in five minutes except the pain continued. Additional information is not expected.

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