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This is VAERS ID 271118

Case Details

VAERS ID: 271118 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Michigan  
Vaccinated:2006-09-27
Onset:2006-09-28
   Days after vaccination:1
Submitted: 2007-01-16
   Days after onset:110
Entered: 2007-01-22
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Acne, Dry skin, Hypersensitivity, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Angioedema (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: Allegra
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0612USA02630

Write-up: Information has been received from the mother of a 14 year old female who on 27 Sep 2006 was vaccinated with a dose of Gardasil. Vaccination the same day included a dose of influenza virus vaccine (unspecified). Concomitant therapy included Allegra. On 28 Sep 2006, the next day, the patient developed little, itchy bumps on her legs and pimple like bumps on her back. The patient''s mother reported that it may or may not have been an allergic reaction, or it "could have been" dry skin. The patient takes therapy with Allegra every day, although, the mother was unsure if the patient had taken it the day of the vaccination. Unspecified medical attention was sought. Subsequently, the patient fully recovered the same day. No other vaccinations have been given. Additional information has been requested.


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