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This is VAERS ID 269240

Case Details

VAERS ID: 269240 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Michigan  
Vaccinated:2006-11-16
Onset:2006-11-18
   Days after vaccination:2
Submitted: 2006-12-14
   Days after onset:26
Entered: 2006-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0612USA00232

Write-up: Information has been received from a physician concerning a female patient who on approximately 16 Nov 2006 was vaccinated with a 0.5ml IM dose of HPV vaccine. Two days later dosage, on approximately 18 Nov 2006 the patient developed a rash at injection site. The patient sought unspecified medical attention. Additional information has been requested. This is in follow-up to report(s) previously submitted on 12/14/2006. The patient was told to take BENADRYL and to make appointment. The patient never kept appointment and the office is “unable to contact her".


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