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This is VAERS ID 279231

Case Details

VAERS ID: 279231 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-04-09
Onset:2007-04-09
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:35
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site haematoma, Injection site reaction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA03191

Write-up: Information has been received from a physician concerning a 15 year old female who on approximately 09-APR-2007 was vaccinated with Gardasil. In April 2007, the patient experienced a crescent shaped burn-like area, over a small hematoma about 1 centimeter in diameter at the injection site. No pain was noted. It was reported that the patient sought unspecified medical attention. It was also reported that the patient is recovering at this time. Additional information has been requested.


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