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This is VAERS ID 284178

Case Details

VAERS ID: 284178 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-02-09
Onset:2007-05-01
   Days after vaccination:81
Submitted: 2007-06-14
   Days after onset:44
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site induration, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA04028

Write-up: Information has been received from a physician concerning a 17 year old female who on 09-FEB-2007 was vaccinated with Gardasil (Lot #655205/1426F). On 27-APR-2007 the patient received her second dose of Gardasil (Lot #655619/1427F) which was given in her left upper arm. Concomitant therapy included medroxyprogesterone acetate (DEPE-PROVERA) which was given to the patient on 27-APR-2007 in the right arm. It was reported that the patient did not experience any adverse effects with the first dose of the vaccine of Gardasil. However, on approximately 01-MAY-2007 the patient experienced warmth, pain and hardness at the injection site where Gardasil was given. It was reported that the patient sought unspecified medical attention. No further details were provided. Additional information has been requested.


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