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This is VAERS ID 283937

Case Details

VAERS ID: 283937 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Hawaii  
Vaccinated:2007-05-07
Onset:2007-05-08
   Days after vaccination:1
Submitted: 2007-06-14
   Days after onset:37
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 3 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Rash macular
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NUVARING
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA02227

Write-up: Information has been received from a physician and follow up information from a health care professional concerning a 21 year old female patient with no drug reactions/allergies who on 07-MAY-2007 was vaccinated IM in the right deltoid with the third dose of Gardasil (Lot #657617/0384U). Concomitant therapy included ethinyl estradiol (+) etonogestrel (NUVARING). On 08-MAY-2007 the patient experienced an injection site reaction of redness, swelling and the area was hot to the touch. There were three red blotches near the injection site including the injection site. No labs were performed. Her outcome was not reported. Additional information is not expected.


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