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This is VAERS ID 263751

Case Details

VAERS ID: 263751 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: New York  
Vaccinated:2006-08-25
Onset:2006-08-26
   Days after vaccination:1
Submitted: 2000-09-26
   Days after onset:2160
Entered: 2006-09-29
   Days after submission:2194
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site reaction, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yasmin
Current Illness: NONE
Preexisting Conditions: possible polycystic ovary syndrome
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Rash at injection site at 24 hours after administration, then rash on other arm (at corresponding site)


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