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This is VAERS ID 264703

Case Details

VAERS ID: 264703 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2006-10-11
Onset:2006-10-12
   Days after vaccination:1
Submitted: 2006-10-12
   Days after onset:0
Entered: 2006-10-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 2 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Acne, 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash/Pimple like on fact and neck. This is in follow-up to report (s) previously submitted on 11/14/2006. Initial and follow-up information has been received from a health professional concerning a 23 year old female with no known allergies who on 11-OCT-2006 at 9:00 was vaccinated with a second dose of GARDASIL (lot # 653978/0955P), intramusculary in the deltoid. Concomitant therapy included ORTHO TRI-CYCLEN. On 12-OCT-2006 at 9:00 AM the patient experienced ''face/neck rash, pimple like stinging.'' It was also received from the FDA through the Freedom of Information Act. There is no additional information. Additional information has been requested.


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