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This is VAERS ID 284461

Case Details

VAERS ID: 284461 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Wisconsin  
Submitted: 2007-06-14
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Injection site erythema, Injection site swelling, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Unknown
Current Illness: Hypersensitivity
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA04145

Write-up: Information has been received from a physician concerning a 20 year old female who in May 2007 was vaccinated with 0.5 ml of the third dose of Gardasil. The patient experienced injection site was red, swollen, and puffed up about a half an inch. The reaction went away about 72 hours after the injection. Medical attention was sought. Additional information has been requested. 10/08/2007 This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a physician concerning her 22 year old daughter with an allergy to chocolate, who on 17-MAY-2007, was vaccinated intramuscularly in the left deltoid with 0.5 ml third dose of GARDASIL (Lot# 657622/0388U). The patient developed a penny size of redness, swelling, and itching that lasted approximately four to five days post vaccination (also reported as 72 hours post vaccination). The patient sought unspecified medical attention. No lab diagnostic studies were taken and there were no illnesses at the time of vaccination. The patient recovered on 21-MAY-2007. Additional information is not expected.

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