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This is VAERS ID 279220

Case Details

VAERS ID: 279220 (history)  
Age: 18.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-04-11
Onset:2007-04-11
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:33
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / - - / 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
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA02838

Write-up: Information has been received from a Medical Assistant (M.A.) concerning an 18 year old female patient who on 04-NOV-2007 was vaccinated in deltoid with a dose of Gardasil lot #656049/0187U. Concomitant therapy included Depo-Provera in the other arm. The patient developed hives about four hours after receiving Gardasil. Benadryl was ordered. The patient''s outcome was unknown. Additional information has been requested.


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