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This is VAERS ID 279225

Case Details

VAERS ID: 279225 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Female  
Location: Mississippi  
Vaccinated:0000-00-00
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: Private       Purchased by: Private
Symptoms: Rash pustular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: WAES0704USA03077

Write-up: Information has been received from a physician, via a company representative, concerning a 10 year old female patient, who was vaccinated with the first dose of Gardasil (date and dose not specified). "About 1 to 2 days later" the patient developed "a pustular rash on her hairline, face and abdomen. " The physician indicated that the patient recovered from the event (date not specified). The patient sought unspecified medical attention. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Initial and follow up information has been received from a physician, via a company representative, concerning a 10 year old female patient, who was vaccinated with the first dose of GARDASIL (date and dose not specified). "About 1 to 2 days later" the patient developed a "strange rash", described as "a pustular rash on her hairline, face and abdomen". The physician indicated that the patient recovered from the event (date not specified). The patient sought unspecified medical attention. No further information is expected.


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