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This is VAERS ID 672989

Case Details

VAERS ID: 672989 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Foreign  
   Days after vaccination:1
Submitted: 2016-09-06
   Days after onset:110
Entered: 2016-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L026017 / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Neck pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1609AUS000736

Write-up: Information was obtained on a request by the Company from the agency via a Public Case Detail (Agency # 388507) concerning a 12 year old male patient. The patient''s medical history and concurrent conditions were not reported. On 18-MAY-2016, the patient was vaccinated with GARDASIL injection lot # L026017, Strength 1, Frequency 1, 2nd injection at school, dose, route and expiry date unknown). On the same day, he was concomitantly vaccinated with chickenpox varicella virus vaccine live (manufacturer unknown) injection. On 19-MAY-2016, he experienced large swelling that doubled arm size and severe pain in neck. The patient sought advice from a health professional. It was reported that the events required a visit to the doctor. The outcome of the events were reported as recovering. The reporter considered the reported events to be possibly related to GARDASIL. The reporter considered the reported events "Neck pain and Extensive swelling of vaccinated limb" to be serious as they caused significant or long term incapacity. Additional information is not expected as follow up information cannot be obtained from local agency.

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