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This is VAERS ID 267455

Case Details

VAERS ID: 267455 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Federated States of Micronesia  
   Days after vaccination:1
Submitted: 2006-11-14
   Days after onset:46
Entered: 2006-11-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653978/0955F / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0610USA12794

Write-up: Information has been received from a registered nurse concerning a 12 year old white female with no know drug allergies, who on 28-SEP-2006 at 14:30 was vaccinated IM into the right deltoid with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). (Lot #653978/0955F). On 29-SEP-2006 at 08:00 the patient experienced a "large red rash area near the injection site, 1x1cm red around injection site and 3x2cm spot in the superior lateral site area, and red raised spot inferior and lateral to the injection site." No diagnostic laboratory studies were performed. The patient was treated with cool compresses, ibuprofen (Advil) or ibuprofen (Motrin) and cetirizine hydorchloride (Zyrtec) every 6 to 8 hours. The patient was told to go to the emergency room if her condition worsened. Subsequently, the patient recovered as there was no more follow up phone calls to the office. Additional information is not expected.

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