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This is VAERS ID 264746

Case Details

VAERS ID: 264746 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-09-11
Onset:2006-09-11
   Days after vaccination:0
Submitted: 2006-10-13
   Days after onset:32
Entered: 2006-10-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Rash maculo-papular
SMQs:, 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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0609USA03257

Write-up: Information has been received from a physician concerning a female patient who on 11-SEP-2006 was vaccinated with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). The physician reported that within 24 hours of receiving the vaccine the patient developed a maculo papular rash all over the body. Medical attention was sought. The patient''s outcome was unknown. Additional information has been requested.


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