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This is VAERS ID 279186

Case Details

VAERS ID: 279186 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-04-03
Onset:2007-04-07
   Days after vaccination:4
Submitted: 2007-05-14
   Days after onset:37
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0284U / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site nodule, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SEASONIQUE
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA01617

Write-up: This is in follow-up to report(s) previously submitted on 5/14/2007. Information has been received from a registered nurse concerning a 26 year old female who on 27-JAN-2007 was vaccinated with Gardasil (lot number "0284U" also reported as 0284J. invalid lot #). Concomitant therapy included SEASONIQUE. On 07-APR-2007 the patient experienced a 1 cm tender nodule at the injection site (deltoid muscle) after receiving her second dose of Gardasil. IM in her left delotid on 03-APR-2007 (previously reported as 04-APR-2007). The patient''s tender nodule persisted. The patient''s outcome was unknown. Additional information is not expected.


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