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This is VAERS ID 279656

Case Details

VAERS ID: 279656 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: New York  
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:18
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Epistaxis, Pain, Pharyngolaryngeal pain
SMQs:, Anaphylactic reaction (broad), 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
Diagnostic Lab Data:
CDC Split Type: WAES0705USA00076

Write-up: Information has been received from a company representative and a nurse concerning a 17 year old female patient who on 26-APR-2007 was vaccinated with Gardasil (lot # 657621/0387U). On 26-APR-2007 the patient experienced body ache, cough, sore throat and a nose bleed. The nurse reported the following: The patient did not go to dance class that night which is unlike her. On 27-APR-2007, the patient went to ''Six Flags:" and only went on one ride which is unlike her. The patient did nothing over the weekend. The patient had 3 nose bleeds that started on 29-APR-2007 and the 3rd nose bleed lasted from 1:15 am on 30-APR-2007. The patient did not go to school on 30-APR-2007. The patient will see her primary care physician for follow-up. The patient was not recovered at the time of the report. Additional information has been requested.

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