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This is VAERS ID 283798

Case Details

VAERS ID: 283798 (history)  
Age: 13.0  
Gender: Female  
Location: Alabama  
Vaccinated:2007-04-20
Onset:2007-04-20
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:55
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Breast cyst
SMQs:

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC Split Type: WAES0705USA01871

Write-up: This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


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