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This is VAERS ID 283797

Case Details

VAERS ID: 283797 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Alabama  
Vaccinated:2007-04-14
Onset:2007-04-17
   Days after vaccination:3
Submitted: 2007-06-14
   Days after onset:58
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Breast pain, Inappropriate schedule of drug administration
SMQs:, Lipodystrophy (broad), Medication errors (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
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA01870

Write-up: Information has been received from a certified medical assistant concerning a 17 year old female who on 14-APR-2007 was vaccinated with the second Gardasil (date of first dose not reported). Subsequently, the patient experienced breast pain. The patient sought unspecified medical attention. Additional information has been requested. This is in follow-uo to previously submitted on 6/14/2007. Information has been received from a certified medical assistant concerning a 17 year old female who on 11-Oct-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 14-APR-2007, the patient was vaccinated in the left deltoid with a second dose of GARDASIL (lot 657617/0384U). The patient had no illness at the time of vaccination. On 17-APR-2007, the patient experienced bilateral breast pain. The patient sought unspecified medical attention. The outcome was unknown. Additional information has been requested.


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