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This is VAERS ID 279206

Case Details

VAERS ID: 279206 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: New York  
   Days after vaccination:3
Submitted: 2007-05-14
   Days after onset:32
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 2 - / IM

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: AUGMENTIN
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0704USA02409

Write-up: Information has been received from a physician, concerning a 16 year old female patient, who on 12-FEB-2007 was vaccinated with the first dose of Gardasil, and reported no symptoms or concerns. On 09-APR-2007, the patient was vaccinated with the second dose, 0.5ml, IM, of Gardasil (Lot #657617/0384U). Concomitant therapy included Augmentin. On 12-APR-2007, three days after the second vaccination was administered, the patient experienced urticaria all over her body, especially on her extremities and face. Treatment included Benadryl. At the time of this report, the physician confirmed the patient was recovering from the urticaria. Additional information has been requested.

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