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This is VAERS ID 267435

Case Details

VAERS ID: 267435 (history)  
Age: 22.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2006-10-11
Onset:2006-10-12
   Days after vaccination:1
Submitted: 2006-11-14
   Days after onset:33
Entered: 2006-11-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / - - / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0610USA09303

Write-up: Information has been received from a physician concerning a 22 year old female who on 11-Oct-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot#653978/0955F) (0.5ml), intramuscularly. Concomitant therapy included ethinyl estradiol/norgestimate (ORTHO TRI-CYCLEN). On 12-Oct-2006 the patient experienced "rash on her face and neck". Unspecified medical attention was sought. At the time of this report, the outcome of the event was unknown. Additional information has been requested.


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