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This is VAERS ID 276890

Case Details

VAERS ID: 276890 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:2
Submitted: 2007-04-13
   Days after onset:21
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0703USA04703

Write-up: Information has been received from a nurse practitioner concerning an 18 year old female patient who on approximately 21-MAR-2007 ("two days ago") was vaccinated with a dose , 0.5ml, of Gardasil vaccine (yeast). Concomitant vaccine administered included tuberculin purified protein derivative. On approximately 21-MAR-2007 the patient "had a reaction after receiving Gardasil (yeast), "described as "a tiny rash on both of her arms." Treatment included diphenhydramine HCl (BENADRYL). The nurse practitioner indicated that the patient was recovering from the rash. At the time of this report, the outcome was uinknown. The NP indicated feeling unsure if the rash was related to GARDASIL. Additional information has been requested. No further information is expected.

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