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This is VAERS ID 277700

Case Details

VAERS ID: 277700 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: New York  
Vaccinated:2007-03-29
Onset:0000-00-00
Submitted: 2007-04-25
Entered: 2007-05-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 2 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Allergy test, Allergy test positive, Hypersensitivity, Rash papular, 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid, Qvar, Nasacort, Xopenex, Evocam topical
Current Illness:
Preexisting Conditions: Ehlers-Danlos Synd; Asthma, Allergy PCN, Keflex, Zithromax
Allergies:
Diagnostic Lab Data: pt had (+) tests to tree, dust, grass
CDC Split Type:

Write-up: shot #1 never seen by me. Saw dermatologist report enclosed "papular urticaria vs. hypersensitivity. Shot #2 never seen by anyone. Mom (R.N.) reported hives forearms, trunk, buttocks


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