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This is VAERS ID 279634

Case Details

VAERS ID: 279634 (history)  
Form: Version 1.0  
Age: 23.0  
Gender: Female  
Location: Pennsylvania  
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:42
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site mass
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: Drug hypersensitivity, allergic reaction to antibiotics
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA06246

Write-up: Information has been received from a health care worker concerning a 23 year old female with drug reactions to "emytin" and Cipro who on 02-APR-2007 was vaccinated intramuscularly with a third dose of Gardasil (Lot # 657006/0188U). On 02-APR-2007 the patient developed a lump on her right arm after administration of the vaccine. The patient sought unspecified medical attention. At the time of this report, the patient''s lump on her right arm persisted. No product quality complaint was involved. Additional information has been requested.

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