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This is VAERS ID 274721

Case Details

VAERS ID: 274721 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Tennessee  
   Days after vaccination:1
Submitted: 2007-03-14
   Days after onset:19
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Polycystic kidney; Blood pressure high
Preexisting Conditions: Hives
Diagnostic Lab Data: None
CDC Split Type: WAES0702USA04636

Write-up: Information has been received from a Physician Assistant (P.A.) concerning a 20 year old female with a history of hives once a year who on 21-FEB-2007 was vaccinated IM with a dose of HPV, lot # 655618/0786U. On 22-FEB-2007 the patient developed hives over her entire body and vomiting. The reporter also noted that in addition to her history of hives, members of her family had a stomach virus with vomiting so it was unclear if her symptoms were from the vaccine. BENADRYL was ordered for the hives. The patient''s outcome was unknown. Additional information has been requested.

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