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This is VAERS ID 272504

Case Details

VAERS ID: 272504 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Florida  
   Days after vaccination:1
Submitted: 2007-02-14
   Days after onset:39
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 2 UN / -

Administered by: Private       Purchased by: Private
Symptoms: Pain of skin, Pruritus, Rash
SMQs:, Anaphylactic reaction (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Unspecified congenital anomaly of heart; Hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0701USA03895

Write-up: Information has been received from an L.P.N. concerning a 13 year old female student with a congenital heart defect and allergy to contrast dye who on the morning of 05-JAN-2007 between approximately 9-11 a.m. was vaccinated in the left upper arm with her second dose of Gardasil (yeast), lot#654389/0961F. In the p.m. of 06-JAN-2007 the patient developed skin tender and some skin "bumps" with pruritis X 2 days. It was reported that on 09-JAN-2007, the patient recovered. No further information is available.

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