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This is VAERS ID 279219

Case Details

VAERS ID: 279219 (history)  
Age: 16.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-04-06
Onset:2007-04-06
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:38
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 6570060188U / 1 LA / UN

Administered by: Private       Purchased by: Other
Symptoms: Injection site rash, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA02778

Write-up: Information has been received from a physician concerning a 16 year old female patient who was vaccinated in left arm with a second dose of Gardasil lot #657006/0188U. Concomitant therapy included Yasmin. On 06-APR-2007 about one hour later receiving the second injection she developed "red blotches" on her left arm (injection site arm) and chest. Unspecified medical attention was sought by the patient. The reaction resolved spontaneously about 4 hours later. Additional information has been requested. This is in follow-up to report(s) previously submitted on 05/14/07. Initial and follow up information has been received from a physician and a health care professional concerning a 16 year old female student who on 05-APR-2007, PM was vaccinated IM in the left arm deltoid with a second dose of GARDASIL lot #657006/0188U. Concomitant therapy included YASMIN. On 06-APR-2007 about one hour later receiving the second injection she developed "red blotches" on her left arm (injection site arm) and chest. Unspecified medical attention was sought by the patient. The outcome was recovered. Follow up information indicated that within an hour of getting the second injection patient had erythematous macular rash on chest which progressed to abdomen and left arm (where injection was given) over next three hours. The reaction resolved spontaneously about 4 hours later. No association of chest pain or shortness of breath. Additional information is not expected.


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