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This is VAERS ID 284167

Case Details

VAERS ID: 284167 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-05-21
Onset:2007-05-21
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:24
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0211U / 3 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Back pain, Injection site pain, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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: WAES0705USA03901

Write-up: Information has been received from a physician concerning a 20 year old female patient who on 21-MAY-2007 was vaccinated IM into the upper left deltoid with a third 0.5 ml dose Gardasil (Lot# 0211U). On 21-MAY-2007, the patient felt faint after receiving the vaccine. A few hours later, the patient''s mother reported that the patient experienced pain that radiated at the injection site up her arm and towards her face. The physician reported that the patient had pain up into her shoulder, radiating to her elbow and down her back. The physician stated that this reaction was pretty minor and not serious however, he thought that patient was just scared. The patient was treated with ice and ibuprofen. It was noted no follow up was necessary. Subsequently, the patient was recovering. No product quality complaint was involved. Additional information is not expected.


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