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This is VAERS ID 274356

Case Details

VAERS ID: 274356 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: California  
Vaccinated:2007-01-23
Onset:2007-01-23
   Days after vaccination:0
Submitted: 2007-02-09
   Days after onset:17
Entered: 2007-03-19
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2176FA / 1 - / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 - / IM

Administered by: Private       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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Broke out in hives within 24 hours of receiving HPV and Flu vaccine.


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