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This is VAERS ID 271125

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 271125
Age:15.0
Gender:Female
Location:Colorado
Vaccinated:2006-12-14
Onset:2006-12-14
Submitted:2007-01-16
Entered:2007-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0697F / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Rash generalised

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxicillin influenza virus vaccine
Current Illness:
Preexisting Conditions: sulfonamide allergy
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 15 year old female with sulfonamide allergy who on 14-Dec-2006 was vaccinated with a first dose of Gardasil vaccine (yeast) (lot#653650/0697F) pre-filled syringe IM into the left deltoid. Concomi"tant vaccination on 14-Dec-2006 included a dose of influenza virus vaccine (unspecified) (manufacturer unknown). On 14-Dec-2006 the patient experienced broke out in rash all over her body. There was no fever associated with the rash. It was unclear if the


Changed on 12/8/2009

VAERS ID: 271125 Before After
Age:15.0
Gender:Female
Location:Colorado
Vaccinated:2006-12-14
Onset:2006-12-14
Submitted:2007-01-16
Entered:2007-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0697F / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Rash generalised

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxicillin influenza virus vaccine
Current Illness:
Preexisting Conditions: sulfonamide allergy
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0612USA02807

Write-up:Information has been received from a physician concerning a 15 year old female with sulfonamide allergy who on 14-Dec-2006 was vaccinated with a first dose of Gardasil vaccine (yeast) (lot#653650/0697F) pre-filled syringe IM into the left deltoid. Concomi"tant Concomitant vaccination on 14-Dec-2006 included a dose of influenza virus vaccine (unspecified) (manufacturer unknown). On 14-Dec-2006 the patient experienced broke out in rash all over her body. There was no fever associated with the rash. It was unclear if there was any local rash or reaction at the injection site. At the same visit the patient was given amoxicillin for an unknown reason. As of 15-Dec-2006 the rash persisted. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=271125&WAYBACKHISTORY=ON


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