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This is VAERS ID 279168

Case Details

VAERS ID: 279168 (history)  
Form: Version 1.0  
Age: 23.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2007-01-19
Onset:2007-01-19
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:114
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Injection site erythema, Injection site irritation, Injection site pain, Smear cervix, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Medication errors (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: ADVAIR
Current Illness: Food allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pap test -
CDC Split Type: WAES0704USA01198

Write-up: Information has been received from a nurse concerning a 23 year old female patient with an unspecified food allergy who on 19-JAN-2007 was vaccinated IM with a first dose of Gardasil lot #654702/0011U. Concomitant therapy included Yasmin and Advair. On 19-JAN-2007 the patient experienced some irritation around the injection site after the first injection. She reported soreness, burning, erythema at injection site. On 05-APR-2007 patient''s father (a physician) administered the second dose of Gardasil lot #656372/0243U to the patient. Within 24 hours of receiving the second injection she developed hives which covered her entire body. The injection site was red, swollen, and burned. She was prescribed Benadryl. The patient was recovering. Additional information has been requested.


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