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This is VAERS ID 276133

Case Details

VAERS ID: 276133 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-12-16
Onset:2006-12-18
   Days after vaccination:2
Submitted: 2007-04-06
   Days after onset:108
Entered: 2007-04-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 654885/1424F / UNK UN / 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMITRIPTYLIN, KEFLEX, FLORINEF, ROZEREM
Current Illness:
Preexisting Conditions: Fibromyalgia; Ehlers-Danlos syndrome; migraine; Insomnia
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA00597

Write-up: Information has been received from a physician concerning a 16 year old female with fibromyalgia, Ehlers-Danlos syndrome, migraine and insomnia and no know drug allergies who on 16, Dec 2006 was vaccinated intramuscularly with a 0.5 mL dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot # 654885/1424F). Concomitant therapy included amitriptyline hydrochloride (AMITRIPTYLIN), ramelteon (ROZEREM), cephalexin (KEFLEX) and fludrocrtisone acetate (FLORINEF). On 18, Dec 2006 (also reported as "several hours after receiving HPV rL1 6 11 16 18 VLP vaccine (yeast)") the patient developed mild hives on her neck. The patient sought unspecified medical attention. No laboratory diagnostic studies were performed. On 19, Dec 2006 ("by the next morning") the hives resolved without treatment. No further problems were reported. No product quality complaint was involved. Additional information has been requested.


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