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This is VAERS ID 263212

Case Details

VAERS ID: 263212 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Arkansas  
   Days after vaccination:0
Submitted: 2006-09-14
   Days after onset:31
Entered: 2006-09-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES0608USA04253

Write-up: Information has been received from a registered nurse concerning a 19 year old female with no pertinent medical history or drug reactions/allergies who on 14-AUG-2006 was vaccinated subcutaneously with "the standard dose" of HPV rLi 6 11 16 18 VLP vaccine (yeast) (lot#653736/0689F). There was no concomitant medication. ON 15-AUG-2006 the patient developed a rash on her face and experienced itching on her face. It was reported that the rash was only on the patient''s face and not at the injection site or any other part of her body. The patient was instructed to take diphenhydramine hydrochloride (BENADRYL). On 17-AUG-2006, in the morning, the patient was instructed to take diphenhydramine hydrochloride (BENADRYL). On 17-AUG-2006, in the morning, the patient called her physician''s office and reported that "it was responding to diphenhydramine hydrochloride (BENADRYL) but had not fully recovered". The patient was scheduled to be seen by her physician on 17-AUG-2006. Additional information has been requested.

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