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This is VAERS ID 284167

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

284167
VAERS Form:
Age:20.0
Gender:Female
Location:Ohio
Vaccinated:2007-05-21
Onset:2007-05-21
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0211U / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Back pain, Injection site pain, Musculoskeletal pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


Changed on 9/14/2017

284167 Before After
VAERS Form:(blank) 1
Age:20.0
Gender:Female
Location:Ohio
Vaccinated:2007-05-21
Onset:2007-05-21
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0211U / 2 3 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Back pain, Injection site pain, Musculoskeletal pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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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