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This is VAERS ID 457894

Case Details

VAERS ID: 457894 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2012-06-21
Entered: 2012-06-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Contusion, Joint swelling, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), 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: ALESSE-28
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1206USA01567

Write-up: Information has been received from an agency (Ref No. 000396733) concerning a 13 year old female patient who on unspecified date was vaccinated with a 0.5 mL dose of GARDASIL (Lot/batch number not reported) given intramuscularly. Concomitant therapy included ALESSE-28. Subsequently on unspecified date, the patient experienced contusion, joint swelling and pain. At the time of the report the patient had not recovered. The agency felt that contusion, joint swelling and pain were related to therapy with GARDASIL and were considered to be disabling. This was originally reported by a pharmacist. Additional information has been requested.


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