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This is VAERS ID 279059

Case Details

VAERS ID: 279059 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:1
Submitted: 2007-05-14
   Days after onset:100
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Rash generalised
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Unk
Diagnostic Lab Data: none
CDC Split Type: WAES0704USA00739

Write-up: Information has been received from a nurse practitioner, via a company representative, concerning a 15 year old female patient, who on 01-FEB-2007 was vaccinated with the first dose of Gardasil (Lot # 655503/0012U). There was no concomitant medication. On 02-FEB-2007, within 24 hours after the vaccination, the patient developed a rash on the arm and trunk. On approximately 04-FEB-2007 ("48 hours later") the patient''s rash spread to the legs. The nurse practitioner stated that the rash "lasted 2 weeks with no fever or itching," and confirmed that the patient had recovered from the rash. The patient sought unspecified medical attention. Additional information has been requested.

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