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This is VAERS ID 263314

Case Details

VAERS ID: 263314 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: California  
Vaccinated:2006-08-28
Onset:2006-08-29
   Days after vaccination:1
Submitted: 2006-09-19
   Days after onset:21
Entered: 2006-09-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 1 LA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2557AA / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Headache, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic rhinitis, RAD
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: On 8/29/06 pt woke up in am to rash on face and fever of 103. Rash not itchy. Treatment Tylenol or Motrin for fever. On 8/30/06 Pt continues with rash on face off and on and also fever continues. Temperature ranging 99.2 - . Also complains of headache.


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