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This is VAERS ID 272595

Case Details

VAERS ID: 272595 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Female  
Location: New York  
Vaccinated:2007-01-16
Onset:2007-01-27
   Days after vaccination:11
Submitted: 2007-02-14
   Days after onset:18
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 655165/1425F / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Rash, Rash erythematous
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0701USA04794

Write-up: Information has been received from a physician concerning a 24 year old female with no pertinent medical history and no known adverse drug reactions or allergies reported. On 16-JAN-2007, the patient was vaccinated with the first dose of Gardasil (yeast). There were no concomitant medications reported. On 27-JAN--2007, the patient developed a rash on her arms and legs. At the time of this report, the outcome of the event was unknown. Additional information has been requested. This is in follow-up information has been rceived from a physician concerning a 24 year old female with no pertinent medical history and no known adverse drug reactions or allergies reported. On 25-JAN-2007 (previously reported as 15-JAN-2007), at approximately 5:45 p.m. the patient was vaccinated IM in the left deltoid with the first dose of GARDASIL (lot #6551565/1425P). There were no concomitant medications reported. On 28-JAN-2007 (previously reported as 27-JAN-2007), the patient developed a red, itchy rash on her arms and legs, reported as worse on the side the patient received her vaccination. The patient was treated with BENADRYL, as directed by the physician. On 01-FEB-2007, the physician spoke to the patient and reported that, at the time of the call, there was improvement of the patient''s rash. No additional information is expected.


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