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This is VAERS ID 283791

Case Details

VAERS ID: 283791 (history)  
Age: 17.0  
Gender: Female  
Location: New York  
Vaccinated:2007-01-15
Onset:2007-01-15
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:149
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1447F / 0 LA / UN

Administered by: Private       Purchased by: Other
Symptoms: Dizziness, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA01682

Write-up: Information has been received from a physician''s assistant concerning a 17 year old white female (132 lbs, 5''4") with an amoxicillin allergy who on 15-JAN-2007 was vaccinated by a nurse with Gardasil, lot # 655617/1447F in the left arm. On 15-JAN-2007 the patient experienced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered. No treatment was sought. Additional information has been requested. Initial and follow up information has been received frm a physician''s assistant concerning a 17 year old female with an AMOXICILLN allergy who on 15-JAN-2007 was vaccinated by a nurse with GARDASIL, lot # 655617/1447F in the left upper arm. The patient had no known illnesses at the time of vaccination. On 15-JAN-2007 the patient experinced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered.


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