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This is VAERS ID 279515

Case Details

VAERS ID: 279515 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Tennessee  
Submitted: 2007-05-14
   Days after onset:43
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Contusion, Injection site erythema, Injection site irritation, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: (therapy unspecified), ADDERALL TABLETS
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA05057

Write-up: Information has been received from a Certified Medical Assistant (C.M.A.) concerning a 21 year old female patient who on 08-FEB-2007 was vaccinated IM with a first dose of Gardasil and on 17-APR-2007 was vaccinated IM in the left deltoid a second dose of Gardasil lot #655849/0263U. Concomitant therapy included Adderall Tablets and thyroid medication (therapy unspecified). A few days after receiving the second injection, the patient developed tenderness, soreness, erythema, swelling. warmth, burning and pruritus in the injection site area of her left arm. She also developed a red bruise on her chest, medical attention was sought. Patient had not recovered. Additional information has been requested.

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