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This is VAERS ID 276848

Case Details

VAERS ID: 276848 (history)  
Form: Version 1.0  
Age: 31.0  
Gender: Female  
Location: New Jersey  
Submitted: 2007-04-13
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Incorrect route of drug administration, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0703USA03994

Write-up: Information has been received from a physician concerning a 31 year old female who was vaccinated with Gardasil. Subsequently the patient developed a severe rash. The patient was vaccinated in the biceps and possibly subcutaneouusly. The patient was not given a second dose to the previous rash. As of 20-MAR-2007, the patient was recovering from the severe rash. The patient sought unspecified medical attention. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/13/2007.

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