National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 279192

Case Details

VAERS ID: 279192 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Texas  
Submitted: 2007-05-14
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Skin induration
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: 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.

New Search

Link To This Search Result:

Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166