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This is VAERS ID 279203

Case Details

VAERS ID: 279203 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2007-04-10
Onset:2007-04-10
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:34
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA02348

Write-up: Information has been received from a registered nurse, concerning a 13 year old female patient, who on 10-APR-2007 was vaccinated with the first dose of Gardasil (Lot #653938/0954F), and developed hives. 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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