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This is VAERS ID 279202

Case Details

VAERS ID: 279202 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: New York  
Vaccinated:2007-03-02
Onset:0000-00-00
Submitted: 2007-05-14
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Rash maculo-papular
SMQs:, 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: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA02346

Write-up: Information has been received from a physician, concerning a 14 year old female patient, who on 02-MAR-2007 was vaccinated with the first dose of Gardasil. There was no concomitant medication. Subsequently the patient experienced a generalized, non-pruritic, maculopapular rash (date not specified). At the time of this report, the patient had not recovered. The patient sought unspecified medical attention. Additional information has been requested.


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