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This is VAERS ID 284482

Case Details

VAERS ID: 284482 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Texas  
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:70
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0705USA04525

Write-up: Information has been received from a physician concerning a 15 year old female who on 05-APR-2007 was vaccinated with Gardasil (Lot#654702/0011U). On 05-APR-2007 post vaccination the patient developed a red swollen arm. Unspecified medical attention was sought. Subsequently on 09-APR-2007 the patient recovered from the red swollen arm. Additional information has been requested. In follow-up it was reported from a physician concerning a 15 year old female student whose reported weight was 158 pounds and whose reported height was 66 3/4 inches who on 05-APR-2007 was vaccinated intramuscularly into the left arm with the first dose of GARDASIL vaccine (yeast) (Lot #654702/0023U). It was reorted that on 05-APR-2007, the patient developed left shoulder and upper arm swelling and pain which lasted for 3 days. The patient recovered on 09-APR-2007. It was reported that the patient recovered. No additional information is expected.

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