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This is VAERS ID 270243

Case Details

VAERS ID: 270243 (history)  
Age: 19.0  
Gender: Female  
Location: Indiana  
Vaccinated:2006-12-01
Onset:2006-12-01
   Days after vaccination:0
Submitted: 2007-01-05
   Days after onset:35
Entered: 2007-01-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other       Purchased by: Other
Symptoms: Pallor, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypotonic-hyporesponsive episode (broad), 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: DEPO-PROVERA
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: WAES0612USA00383

Write-up: Information has been received from a health professional concerning a female patient who on 01-Dec-2006 was vaccinated IM with a 0.5 ml dose of HPV vaccine (yeast). It was noted that medroxyprogesterone acetate (DEPO-PROVERA) may have been given concomitantly. On 01-Dec-2006 the patient developed hives and turned pale white. She was admitted to the emergency room and there was no further information if she will be admitted. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.


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