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This is VAERS ID 279041

Case Details

VAERS ID: 279041 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: California  
Vaccinated:2007-03-24
Onset:2007-03-26
   Days after vaccination:2
Submitted: 2007-05-14
   Days after onset:49
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Genital rash, Vulvovaginal pruritus
SMQs:, Hypersensitivity (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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA00365

Write-up: Information has been received from a physician concerning a 12 year old female patient who on 24-MAR-2007 was vaccinated with a second dose of Gardasil. On 26-MAR-2007 the patient developed a rash around the genital area and vaginal itch. It was unknown whether the physician plan to administer the third dose. Unspecified medical attention was sought. At the time of this report, the patient''s outcome was unknown. Additional information has been requested.


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