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This is VAERS ID 269215

Case Details

VAERS ID: 269215 (history)  
Form: Version 1.0  
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. 0697F / 1 - / IM

Administered by: Private       Purchased by: Other
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: UNK
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0611USA05796

Write-up: Information has been received from a physician concerning a 16 year old female with no known drug allergies who on 08 Nov 2006, at 4:00 PM, was vaccinated IM with the first dose of HPV vaccine. On 09 Nov 2006, the patient developed a drug rash. The patient sought unspecified medical attention. On 14 Nov 2006, the patient was recovered from the drug rash. Additional information is not expected.


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