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This is VAERS ID 277112

Case Details

VAERS ID: 277112 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: New York  
   Days after vaccination:0
Submitted: 2007-04-19
   Days after onset:103
Entered: 2007-04-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Immediate post-injection reaction, Injection site swelling, Rash pruritic, Scab, Skin exfoliation, Swelling
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0704USA01525

Write-up: Information has been received from a registered nurse at a dermatology office, concerning a 17 year old female patient who on 20-SEP-2006 was vaccinated with the first dose of Gardasil (Lot #653736/0868F), and on 05-JAN-2007, with the second dose of Gardasil (Lot #655165/1425F) at an OB-GYN office. The nurse reported that on 05-JAN-2007, following the second vaccination, the patient, immediately got at bump on the right arm," by approximately 19-JAN-2007 ("within 2 weeks of the vaccination"), the patient''s "arm was cabby, scaly and bigger, than spread to whole body and face;" the patient developed a severe rash with itching. Prior to the first visit at the dermatology office, the nurse confirmed that the patient reported she had received treatment (date not specified) from a clinic, involving 2 courses of methylprednisone and cephalexin. On 27-JAN-2007, when the patient initially visited the dermatology office, the nurse indicated that the rash "looked like a sunburn that had peeled, was swollen, flaked and scabbed." Treatment on 27-JAN-2007 included an injection of DEPO-MEDROL), MOISTEREL cream (OTC). At the time of this report, it was unknown if the patient had recovered; the patient had a follow up visit scheduled at the dermatology office for 17-APR-2007. The reporter considered the severe rash with itching, peeling, swelling, flaking and scabbing to be disabling as the patient had missed school, and also an other medical event. Additional information has been requested.

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