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This is VAERS ID 274112

Case Details

VAERS ID: 274112 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Utah  
   Days after vaccination:18
Submitted: 2007-03-14
   Days after onset:40
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Injection site discolouration, Similar reaction on previous exposure to drug, Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (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: Yasmin
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES0702USA00416

Write-up: This is in follow-up to report(s) previously submitted on 3/14/2007. Information has been received from a physician concerning a 19 year old female with penicillin allergy who on 02-NOV-2006 was vaccinated intramuscularly in the right arm with GARDASIL (Lot # not provided). Concomitant therapy included Yasmin. On 14-JAN-2007 the patient received her second vaccination of GARDASIL (Lot #653735/0688F) intramuscularly in the left arm. On approximately 09-NOV-2006 the patient experienced a lighter coloring of the skin at the injection site. It was reported that the patient did not experience any itching or swelling. On approximately 21 Jan 2007 the patient experienced lighter coloring of the skin at the injection site. Follow up information confirmed that on 01-FEB-2007 the patient experienced lighter coloring of the skin at the injection site. At the time of this report the patient''s skin discoloration in both arms had not resolved. Additional information has been requested.

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