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This is VAERS ID 269180

Case Details

VAERS ID: 269180 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2006-11-02
Onset:2006-11-03
   Days after vaccination:1
Submitted: 2007-04-06
   Days after onset:153
Entered: 2006-12-18
   Days after submission:108
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Arthropod bite, Menorrhagia, Migraine, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), 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: None
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0611USA02908

Write-up: Information has been received from an office manager concerning a 14 year old female who on 02-Nov-2006 was vaccinated intramuscularly in the arm with a 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). On 03-Nov-2006 the patient started her menses and experienced a migraine. On 06-Nov-2006 the patient experienced a rash on her vaccinated arm which also spread to her face. Unspecified medical attention was sought. The patient was treated with diphenhydramine (BENADRYL) and the rash had subsided. AT the time of report, the patient was recovering from the migraine. No product quality complaint was involved. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Information has been received from an office manager concerning a 14 year old female with no pertinent medical history who on 02-NOV-2006, at 15:00, was vaccinated intramuscularly in the left arm with a 0.5 ml first dose of GARDASIL. On 03-NOV-2006 the patient started her menses and experienced a migraine. On 06-NOV-2006 the patient developed hives on her vaccinated arm which also spread to her face. Unspecified medical attention was sought. The patient was treated with BENADRYL and the rash had subsided. At the time of report, the patient was recovering from the migraine. Follow-up reported that the patient had a new puppy with fleas. The pediatrician diagnosed that the rash was due to flea bites and not due to an allergy. The patient was expected to received the second dose in January 2007. No product quality complaint was involved. Additional information is not available.


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