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This is VAERS ID 274731

Case Details

VAERS ID: 274731 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Illinois  
Vaccinated:2006-12-28
Onset:0000-00-00
Submitted: 2007-03-14
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 1 - / IM

Administered by: Other       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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA, CONCERTA
Current Illness: Depression
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA00074

Write-up: Information has been received from a Registered Nurse (R.N.) concerning a 16 year old female patient with depression who on 28-DEC-2006 was vaccinated IM with her first dose of Gardasil, lot #654389/0961F. Concomitant therapy included CONCERTA and DEPO-PROVERA. The patient developed a generalized "hive like rash" after her first dose of Gardasil. The nurse reported that the rash "comes and goes". Unspecified medical attention was sought. The patient had not recovered as of the report date. Additional information has been requested.


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