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This is VAERS ID 279192

Case Details

VAERS ID: 279192 (history)  
Age: 19.0  
Gender: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-05-14
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IJ

Administered by: Other       Purchased by: Other
Symptoms: Skin induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA02168

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female who on an unspecified date was vaccinated with first dose of Gardasil (lot # not reported). The patient sought medical attention. On an unspecified date, the patient developed a "smallpox like mark" or skin indentation right below the injection site. At the time of reporting, the outcome was unknown. Additional information has been requested. Additional information was received. It was reported that they did not give the vaccination. The patient had the "bad experience" elsewhere. Follow up information received stated that on 09-OCT-2007 the patient was administered the second dose of GARDASIL (lot # not provided). The nurse who administered the vaccine reported that when she administered the vaccine some of the vaccine ran down the patienr''s arm. She stated she believed it happened because of technigue and possible tense muscle. No symptoms or probllemms were noted, No additional information is expected.


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