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This is VAERS ID 276127

Case Details

VAERS ID: 276127 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Indiana  
Vaccinated:2007-01-12
Onset:2007-01-12
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:83
Entered: 2007-04-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0697F / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo-Provera; ALLEGRA
Current Illness: Allergic reaction to antibiotics; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: body temp, 01/12/07, 102
CDC Split Type: WAES0703USA00443

Write-up: This is in follow-up to reports(s) previously submitted on 4/6/2007. Initial and follow-up information has been received from a registered nurse concerning a 22 year old female with allergies to tetracycline, VICODIN and TRAMADOL who on 12-JAN-2007 at 1:45 PM, was vaccinated IM into the left arm with a 0.5 mL first dose of GARDASIL (Lot# 653650/0697F). There was no illness at the time of vaccination. Concomitant therapy included medroxyprogesterone acetate (DEPO-PROVERA) and ALLEGRA. On 13-JAN-2007 the patient called complaining of a fever that started on the day of the injection at 8:00PM. The fever was about 102 degrees. Subsequently, the patient recovered and there were no other problems reported. Additional information is not expected.


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