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This is VAERS ID 283766

Case Details

VAERS ID: 283766 (history)  
Age: 18.0  
Gender: Female  
Location: Illinois  
Vaccinated:2007-04-11
Onset:2007-04-11
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:64
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0089U / 0 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site pain, Injection site vesicles
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA; FLAGYL
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0705USA01113

Write-up: Information has been received from a nurse practitioner concerning an 18 year old white female who on 11-APR-2007 at 15:00 was vaccinated, intramuscularly in the right deltoid, with a first 0.5 ml dose of Gardasil (Lot #655324/0089U). Concomitant therapy included medroxyprogesterone acetate (DEPO-PROVERA) and metronidazole (FLAGYL). On 11-APR-2007, several hours after the vaccination, the patient developed a blister-like reaction at the injection site and at 15:00 experienced prolonged injection site pain (for three weeks). At the time of this report the patient''s outcome for blister-like reaction at injection site was unknown. No product quality complaint was involved. Additional information is not expected.


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