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This is VAERS ID 279063

Case Details

VAERS ID: 279063 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-01-11
Onset:2007-01-18
   Days after vaccination:7
Submitted: 2007-05-14
   Days after onset:115
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Rash, 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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dicloxacillin
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC Split Type: WAES0704USA00770

Write-up: Information has been received from a physician (allergist) concerning a female between 18 to 20 years old who on 11-JAN-2007 was vaccinated with first dose of Gardasil. Concomitant therapy included dicloxacillin from 04-JAN-2007 to 14-JAN-2007. On 28-JAN-2007, the patient developed a hives rash over her arms and legs when administered the vaccine. The patient sought unspecified medical attention. Additional information has been requested.


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