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This is VAERS ID 272505

Case Details

VAERS ID: 272505 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-01-01
Onset:2007-01-01
   Days after vaccination:0
Submitted: 2007-02-14
   Days after onset:44
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 2 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0701USA03908

Write-up: Information has been received from a physician concerning a female (demographics not reported) who on an unspecified date was vaccinated with Gardasil (yeast) (Lot# not provided). Subsequently the patient developed hives. At the time of this report it was unknown if the patient had recovered from the hives. Additional information has been requested. This is in follow-up to report(s) previously submitted on 2/14/2007. Follow up information received stated that the patient developed hives after receiving the second dose of GARDASIL (Lot # not provided) on an unspecified date in approximately January, 2007. The patient was treated in the physicians office with a dose of an unspecified antihistamine. At the time of this report it was not reported if the patient had recovered from the event. Additional information has been requested.


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