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This is VAERS ID 269916

Case Details

VAERS ID: 269916 (history)  
Form: Version 1.0  
Age: 31.0  
Gender: Female  
Location: New York  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Pruritus generalised, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None Drug hypersensitivity
Preexisting Conditions: Allergic to depacote, Lortab, nuerontin, valicum,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt called 12/20/06 and reported that on the evening of 12/18/06 she developed generalized itching and hives, no other symptoms. She was instructed to take 25mg Benadryl Q 6H when needed. No further vaccinations will be administered per Dr.p report has been received from a registered nurse concernng a 31 year old female with drug allergies to DEPAKOTE, LORTAS, NEURONTIN, VALIUM and FIORICET. On 18-DEC-2006 (also reported as 18-DEC-1976) the patient was vaccinated with her first dose of GARDASIL (Lot number 65450/1161F) intramuscularly in the left deltoid. On 18-DEC-2006 in the eveneing, the patient experienced generalized itching and hives. The patient was instructed to take BENADRYL 25 mg every 6-8 hours until the itching subsided. The patient was informed that she will not be receiving the additional 2 vaccinations. Additional informationis not expected.

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