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This is VAERS ID 279529

Case Details

VAERS ID: 279529 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: New Mexico  
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:33
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Injection site swelling, Lethargy, Malaise, Nodule, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MIRCETE; LEVOXYL; paroxetine
Current Illness: Hypothyroidism; Drug Hypersensitivity; Allergic reaction to antibiotics
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type: WAES0704USA04810

Write-up: Information has been received from a physician''s assistant concerning a 28 year old female (67inches, 227lbs.) with hypothyroidism, drug hypersensitivity to morphine sulfate, DEMEROL and ZITHROMAX who on 11-APR-2007 was vaccinated with the first dose of Gardasil (Lot#657617/0384U) intramuscularly in the left deltoid. Concomitant therapy included paroxetine, LEVOXYL and MIRCETE. Within 24 hours, on 12-APR-2007, the patient experienced significant swelling at injection site, swelling/swollen nodular area over left clavicle, significant malaise/lethargy and low grade fever. As of 20-APR-2007 the patient was significantly improved and considered recovered. The patient declined an appointment. Additional information has been requested.

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