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This is VAERS ID 279171

Case Details

VAERS ID: 279171 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-03-29
Onset:2007-03-29
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:46
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0243U / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood pressure, Dizziness, Drug administered at inappropriate site, Stomach discomfort
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Medication errors (narrow)

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: Sulfonamide allergy; House dust allergy; Mycotic allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood pressure 03/29/07 117/8 total heartbeat count 03/29/07 63
CDC Split Type: WAES0704USA01288

Write-up: Information has been received from a registered nurse concerning a 20 year old female patient with allergies to Sulfa, dust and mold who on 29-MAR-2007 was vaccinated IM into the left deltoid (previously reported as gluteus) with a first dose of Gardasil (lot # 656372/0243U). The patient became faint after the injection, but did not lose consciousness. The patient put her head down, used a cool cloth, spirits of ammonia and laid down in the exam table. The patient was give apple juice. The patient''s blood pressure was 117/86 with a pulse of 63. On 30-MAR-2007, the patient returned to the office and stated that she had felt woosy and experienced a sensitive stomach the 24 hours following the vaccination. The patient recovered from her experience on 30-MAR-2007. No product quality complaint was involved. Additional information is not expected.


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