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This is VAERS ID 279036

Case Details

VAERS ID: 279036 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2006-09-01
Submitted: 2007-05-14
   Days after onset:255
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug administered at inappropriate site, Injection site erythema, Injection site mass, Injection site pain, Injection site scar, Skin discolouration
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow)

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: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0704USA00305

Write-up: Information has been received from a registered nurse concerning her 25 year old daughter who in September 2006, was vaccinated with her first dose of Gardasil, intramuscular injection in "gluteal region". There was no concomitant medication. In November 2006, the patient received her second dose of Gardasil, intramuscular injection in deltoid. On 08-MAR-2007, the patient received her third dose of Gardasil, intramuscular injection in deltoid. On 09-MAR-2007, the patient experienced tenderness at injection site, erythema at injection site, a raised lump size of quarter at injection site and scar at injection site which was described as the skin being discolored and having a different texture with underlying hardness. As of 02-APR-2007, the patient had not recovered. The product quality complaint unit was not involved. Additional information has been requested.


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