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This is VAERS ID 284132

Case Details

VAERS ID: 284132 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: California  
Vaccinated:2007-05-03
Onset:2007-05-03
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:42
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0388U / 1 GM / IM

Administered by: Private       Purchased by: Other
Symptoms: Drug administered at inappropriate site, Injection site erythema, Injection site mass, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (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: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA03167

Write-up: Information has been received from a medical assistant concerning a 17 year old female who on 03-MAY-2007 was vaccinated with first dose of Gardasil (lot # 657622/0388U) IM in the right gluteal muscle. There was no concomitant medication. On 04-MAY-2007, the patient developed redness, a bump, and itchiness at the injection site which was the gluteus muscle. Medical attention was sought. At the time of reporting, the patient recovered. Additional information has been requested. 10/08/07 This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a medical assistant concerning a 17 year old female with no illness at the time of vaccination and no history of allergies or medical conditions who on 03-MAY-2007 was vaccinated with first dose of GARDASIL (lot # 657622/0388U) IM in the right gluteal muscle at approximately 2 PM. There was no concomitant medication. On 04-MAY-2007, the patient developed redness, a bump, and itchiness at the injection site which was the gluteus muscle. Medical attention was sought. At the time of reporting, the patient had recovered. Additional information was received from a family nurse practitioner who reported that the outcome of the events was unknown (previously stated as recovered). No additional information is expected.


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