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This is VAERS ID 276557

Case Details

VAERS ID: 276557 (history)  
Age: 16.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-03-22
Onset:2007-03-25
   Days after vaccination:3
Submitted: 2007-03-29
   Days after onset:4
Entered: 2007-04-17
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1853BB / 0 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Pityriasis rosea, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received vaccines 3/22/07, developed hives on stomach and back 3/25/07. On 4-3-07 saw a dermatologist and was diagnosed with pityriasis rosea.


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