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This is VAERS ID 267479

Case Details

VAERS ID: 267479 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Female  
Location: California  
   Days after vaccination:0
Submitted: 2006-11-14
   Days after onset:44
Entered: 2006-11-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0689F / 1 UN / -

Administered by: Other       Purchased by: Other
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), 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: NONE
Current Illness:
Preexisting Conditions: Hives, food allergies.
Diagnostic Lab Data: NONE
CDC Split Type: WAES0611USA00701

Write-up: Information has been received from a certified medical assistant and a physician concerning a 25 year old female with a history of hives due to orange juice who in approximately Oct 2006, a couple of weeks ago, was vaccainted with a 0.5ml first dose of HPV vaccine (lot 653736/0689F). There was no concomitant medication. Approximately 30 minutes after the vaccination, the pt experienced severe itching all over her body. It was reported that there was no rash. Unspecified medical attention was sought. Subsequently, the pt recovered after approximately 2 days. Additional information has been requested.

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