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This is VAERS ID 269204

Case Details

VAERS ID: 269204 (history)  
Age: 16.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2006-11-08
Onset:2006-11-09
   Days after vaccination:1
Submitted: 2006-12-14
   Days after onset:35
Entered: 2006-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES0611USA04681

Write-up: Information has been received from a physician concerning a 16 year old female who on 08 Nove 2006 was vaccinated intramuscularly with the first dose of Gardasil (yeast) (Lot # not provided). On 09 Nov 2006 it was reported that the patient developed hives. Unspecified medical attention was sought. At the time of this report it was unknown if the patient had recovered. Additional information has been requested.


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