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This is VAERS ID 281539

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

281539
VAERS Form:
Age:17.0
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-05-30
Submitted:2007-06-12
Entered:2007-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain in extremity, Thrombectomy, Deep vein thrombosis, Pneumatic compression therapy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ultrasound 06/04/07 - thrombosis in the left arm records received 6/21/07-Color duplex ultrasound of upper extremity venous system demonstrated acute deep vein thrombosis in left arm.
CDC 'Split Type':

Write-up:Information has been received from a nurse concerning a 17 year old female who on 30-MAY-2007 was vaccinated with Gardasil (Lot #657621/0387U). There was no concomitant medication. On 30-MAY-2007 the patient developed impressive swelling and pain in her l"eft shoulder down to her wrist. This occurred after the patient went swimming. It was reported that /"the swelling gets less when the arm is not used but comes back when the patient uses the arm/". A physician in the office told the patient to elevate and


Changed on 12/8/2009

281539 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-05-30
Submitted:2007-06-12
Entered:2007-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Oedema peripheral, Pain in extremity, Thrombectomy, Thrombolysis, Thrombosis, Ultrasound Doppler abnormal, Deep vein thrombosis, Pneumatic compression therapy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ultrasound 06/04/07 - thrombosis in the left arm records received 6/21/07-Color duplex ultrasound of upper extremity venous system demonstrated acute deep vein thrombosis in left arm.
CDC 'Split Type': (blank) WAES0706USA00602

Write-up:Information has been received from a nurse concerning a 17 year old female who on 30-MAY-2007 was vaccinated with Gardasil (Lot #657621/0387U). There was no concomitant medication. On 30-MAY-2007 the patient developed impressive swelling and pain in her l"eft left shoulder down to her wrist. This occurred after the patient went swimming. It was reported that /"the "the swelling gets less when the arm is not used but comes back when the patient uses the arm/". arm". A physician in the office told the patient to elevate and ice the arm in the area for a couple of days, but this did not help. On 04-JUN-2007 a Doppler ultrasound was performed which revealed thrombosis in the arm. It was reported that the swelling and pain were disabling to the patient. The patient''s swelling and pain persisted. No further information is available at this time. Additional information has been requested. 6/21/07-records received for DOS 6/11 and 6/17/07- Letter from PCP indicated that DVT is not thought to be due to vaccine it has probably been present for a few weeks. unfortunately it began to grow around the time of HPV thus the apparent association. Received HPV 5 days ago from this visit of 6/4/07-developed impressive swelling and pain that day while swimming. Arm literally twice normal size with pitting edema into arm pit. Swelling lessesn when not using arm but returns when she tries to swim or exerices. PE:left arm with non pitting swelling over entire arm, skin over arm is warm and well perfused fingers are cool on both hands but well perfused. ROM fine. Treatment, thrombolysis and mechanical thrombectomy, subclavian vein was virtually completely freed of thrombus. An underlying compression of the vein at the thoracic inlet was documented


Changed on 2/14/2017

281539 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-05-30
Submitted:2007-06-12
Entered:2007-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Oedema peripheral, Pain in extremity, Thrombectomy, Thrombolysis, Thrombosis, Ultrasound Doppler abnormal, Deep vein thrombosis, Pneumatic compression therapy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ultrasound 06/04/07 - thrombosis in the left arm records received 6/21/07-Color duplex ultrasound of upper extremity venous system demonstrated acute deep vein thrombosis in left arm.
CDC 'Split Type': WAES0706USA00602

Write-up:Information has been received from a nurse concerning a 17 year old female who on 30-MAY-2007 was vaccinated with Gardasil (Lot #657621/0387U). There was no concomitant medication. On 30-MAY-2007 the patient developed impressive swelling and pain in her left shoulder down to her wrist. This occurred after the patient went swimming. It was reported that "the swelling gets less when the arm is not used but comes back when the patient uses the arm". A physician in the office told the patient to elevate and ice the arm in the area for a couple of days, but this did not help. On 04-JUN-2007 a Doppler ultrasound was performed which revealed thrombosis in the arm. It was reported that the swelling and pain were disabling to the patient. The patient''s swelling and pain persisted. No further information is available at this time. Additional information has been requested. 6/21/07-records received for DOS 6/11 and 6/17/07- Letter from PCP indicated that DVT is not thought to be due to vaccine it has probably been present for a few weeks. unfortunately it began to grow around the time of HPV thus the apparent association. Received HPV 5 days ago from this visit of 6/4/07-developed impressive swelling and pain that day while swimming. Arm literally twice normal size with pitting edema into arm pit. Swelling lessesn when not using arm but returns when she tries to swim or exerices. PE:left arm with non pitting swelling over entire arm, skin over arm is warm and well perfused fingers are cool on both hands but well perfused. ROM fine. Treatment, thrombolysis and mechanical thrombectomy, subclavian vein was virtually completely freed of thrombus. An underlying compression of the vein at the thoracic inlet was documented


Changed on 9/14/2017

281539 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Unknown
Vaccinated:2007-05-30
Onset:2007-05-30
Submitted:2007-06-12
Entered:2007-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Oedema peripheral, Pain in extremity, Thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: ultrasound 06/04/07 - thrombosis in the left arm records received 6/21/07-Color duplex ultrasound of upper extremity venous system demonstrated acute deep vein thrombosis in left arm.
CDC 'Split Type': WAES0706USA00602

Write-up:Information has been received from a nurse concerning a 17 year old female who on 30-MAY-2007 was vaccinated with Gardasil (Lot #657621/0387U). There was no concomitant medication. On 30-MAY-2007 the patient developed impressive swelling and pain in her left shoulder down to her wrist. This occurred after the patient went swimming. It was reported that "the swelling gets less when the arm is not used but comes back when the patient uses the arm". A physician in the office told the patient to elevate and ice the arm in the area for a couple of days, but this did not help. On 04-JUN-2007 a Doppler ultrasound was performed which revealed thrombosis in the arm. It was reported that the swelling and pain were disabling to the patient. The patient''s swelling and pain persisted. No further information is available at this time. Additional information has been requested. 6/21/07-records received for DOS 6/11 and 6/17/07- Letter from PCP indicated that DVT is not thought to be due to vaccine it has probably been present for a few weeks. unfortunately it began to grow around the time of HPV thus the apparent association. Received HPV 5 days ago from this visit of 6/4/07-developed impressive swelling and pain that day while swimming. Arm literally twice normal size with pitting edema into arm pit. Swelling lessesn when not using arm but returns when she tries to swim or exerices. PE:left arm with non pitting swelling over entire arm, skin over arm is warm and well perfused fingers are cool on both hands but well perfused. ROM fine. Treatment, thrombolysis and mechanical thrombectomy, subclavian vein was virtually completely freed of thrombus. An underlying compression of the vein at the thoracic inlet was documented


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