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This is VAERS ID 271168

Case Details

VAERS ID: 271168 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2006-12-14
Onset:2006-12-14
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:112
Entered: 2007-01-22
   Days after submission:73
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 6537360868F / 2 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: 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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0701USA00462

Write-up: Information has been received from an RN concerning a patient who has an allergic reaction after being vaccinated with a dose of Gardasil vaccine (yeast). The patient''s outcome was unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 1/16/2007. Initial and follow up information has been received from an RN concerning a 16 year old female student who on 14-DEC-2006 at 5:00 P.M. was vaccinated IM in left deltoid with her second dose of GARDASIL, lot #653736/0868F. The patient developed an allergic reaction after being vaccinated (onset reported as the morning of "05-DEC-2006"), an itchy rash on the inside of her arms. She was treated with BENADRYL and recovered. Additional information is not expected.


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