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This is VAERS ID 276119

Case Details

VAERS ID: 276119 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2007-02-26
Onset:2007-02-27
   Days after vaccination:1
Submitted: 2007-04-06
   Days after onset:37
Entered: 2007-04-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / UNK UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Rash
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA00367

Write-up: Information has been received from a nurse practitioner concerning a 24 year old female, with no pertinent medical history, who on 26-FEB-2007 was vaccinated with Gardasil (LOT# 654702/0011U). There was no concomitant therapy. On 26-FEB-2007, within 24 hours of Gardasil administration, the patient experienced a rash on her abdomen. The patient had phoned the office to report the rash. The rash was not seen by the nurse practitioner or physician. No prescription medication therapy was provided to the patient. Subsequently, the patient recovered in 1 day. Additional information has been requested. This is in follow-up to report(s) previously submitted on 4/6/2007. Initial and follow-up information has been received from a nurse practitioner (N.P.) concerning a 24 year old female, with no pertinent medical history, who on 26-FEB-2007 was vaccinated IM with a dose of GARDASIL (LOT# 654702/0011U). There was no concomitant therapy. On 26-FEB-2007, within 24 hours of GARDASIL administration, the patient experienced a rash on her abdomen. The patient had phoned the office to report the rash. The rash was not viewed by the nurse practitioner or physician. No prescription medication therapy was provided to the patient. Subsequently, the patient recovered in 1 day. Additional information is not expected.


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