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This is VAERS ID 278152

Case Details

VAERS ID: 278152 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2007-04-27
Onset:2007-04-27
   Days after vaccination:0
Submitted: 2007-05-04
   Days after onset:7
Entered: 2007-05-08
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1282F / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B002AA / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Heart rate, Heart rate normal, Rash pruritic, Respiratory rate increased
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg 11:00am, Benadryl 50mg 1:12 pm
Current Illness: None known
Preexisting Conditions: allergy testing and injection (weekly) Tree, grass, and + allergy injection
Allergies:
Diagnostic Lab Data: Temp 97.5, BP 102/58, AHR 90 Resp. 24 Schedule for allergy tests with allergist in approximately one month
CDC Split Type:

Write-up: Student came to Student Health Center at 105 pm complaining of a pruritic rash on arms, back stomach and neck - denies any additional symptoms of concern. Have appt. today already scheduled with allergist (state first noted itching at about 11:45 am) rash eased within 15 minutes of Benadryl.


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