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This is VAERS ID 279656

Case Details

VAERS ID: 279656 (history)  
Age: 17.0  
Gender: Female  
Location: New York  
Vaccinated:2007-04-26
Onset:2007-04-26
   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
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - - / IM

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
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
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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