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This is VAERS ID 274204

Case Details

VAERS ID: 274204 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2007-02-02
Submitted: 2007-03-14
   Days after onset:39
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Rash generalised
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0702USA01396

Write-up: Information has been received from a nurse practitioner concerning a female (age unknown) who, on an unspecified date, was vaccinated intramuscularly with a 0.5 ml dose of Gardasil. The patient was administered Gardasil in one arm ant Tetanus vaccine in the other arm on the same day. On approximately 02-FEB-2007 the patient developed a rash on her whole body. The patient sought unspecified medical attention. No laboratory diagnostic studies were performed. At the time of this report, the outcome was unknown. No product quality complaint was involved. no additional information is available.


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