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This is VAERS ID 408006

Case Details

VAERS ID: 408006 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 2010-11-11
   Days after onset:35
Entered: 2010-11-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Analgesic therapy, Oedema peripheral, Pain, Pain in extremity, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness: Asthma
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1011USA00283

Write-up: This case was received from a Health Authority (ADR no. 20723424). A 12 year old patient with a medical history of mild asthma treated with salbutamol (as necessary) received an IM injection of GARDASIL (manufacturer and batch number not reported) on 07-OCT-2010. On the same day as vaccination, the patient developed a painful swollen arm. At the time of reporting the arm was still tender to touch, on passive and active movement. The patient required analgesia and physiotherapy four days post vaccination. The patient outcome was not recovered. This case was medically confirmed. The reported considered the events to be serious for disability/incapacity and being medically significant. The MHA coded the event of painful arm and swollen arm. Other business partner numbers included: E2010-06538. No further information is available.

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