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This is VAERS ID 275992

Case Details

VAERS ID: 275992 (history)  
Age: 11.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2007-03-04
Onset:0000-00-00
Submitted: 2007-04-10
Entered: 2007-04-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Stevens-Johnson syndrome
SMQs:, Severe cutaneous adverse reactions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA00776

Write-up: Information has been received from a physician concerning a friend of a friend''s 11 or 12 year old daughter who on approximately 04-MAR-2007 ("about 1 month ago") was vaccinated with a first dose of Gardasil. In approximately March 2007, the patient developed Stevens-Johnson Syndrome and was hospitalized. Her recovery status was unknown at the time of the report. Additional information has been requested.


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