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This is VAERS ID 274123

Case Details

VAERS ID: 274123 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: New Jersey  
   Days after vaccination:0
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 rash, 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yasmin
Current Illness: Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0702USA00727

Write-up: Information has been received from a registered nurse concerning a 19 year old female student (63 inches, 112 lbs) with no illness at the time of vaccination and with a penicillin allergy. On 01-FEB-2007, at approximately 14:00 PM, the patient was vaccinated in the left arm with the first 0.5 mL dose of HPV (lot# 655619/1427F). Concomitant therapy included Yasmin. On that same day, at 4:00 PM, the patient developed a rash on her left arm from the injection site to the elbow and a rash also on her right arm (unspecified where on her right arm). The patient sought unspecified medical attention. The physician prescribed over-the-counter Benadryl and contacted the patient the next day for follow up. The patient reported that she was fine. At the time of this report, the patient had recovered from the event (date unknown). Additional information has been requested. Additional infromation is not expected.

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