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This is VAERS ID 276849

Case Details

VAERS ID: 276849 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: New York  
Vaccinated:2007-03-15
Onset:2007-03-17
   Days after vaccination:2
Submitted: 2007-04-13
   Days after onset:27
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0244U / 2 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Rash, Rash papular, Rash pruritic, 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA03997

Write-up: This is in follow-up to report(s) previously submitted on 4/13/2007. Initial and follow up information has been received from a physician and a health care professional concerning a 15 year old female who on 15-MAR-2007 at 11:00 AM was vaccinated in the left arm with a second dose of GARDASIL lot #65605/0244U. On 15-MAR-2007, the patient received her second dose and experienced generalized hives which the physician described as a migratory rash. The patient sought unspecified medical attention. The patient tolerated her first dose well. In follow-up it was indicated that on 17-MAR-2007 patient had painful, itchy rash raised, on right arm, face, left fore arm. She was advised to give 25 milligram BENADRYL every 6 hours until no hives for 24 hours. Subsequently, on 04-APR-2007 the patient recovered from generalized hives and migratory rash. Additional information is not expected.


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