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This is VAERS ID 279226

Case Details

VAERS ID: 279226 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-04-13
Onset:2007-04-15
   Days after vaccination:2
Submitted: 2007-05-14
   Days after onset:29
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 1 RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Rash erythematous
SMQs:, Anaphylactic reaction (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0704USA03094

Write-up: Initial and follow up information has been received from a pharmacist, concerning a 16 year old female patient with no pertinent medical history, who on 13-APR-2007, approximately 9:30am, was vaccinated IM in the right deltoid, with the first dose, 0.5ml, of GARDASIL (Lot #654885/1424F). There was no concomitant medication. It was unknown if there was any illness at the time of vaccination. On 15-APR-2007 the patient developed a full body rash. The pharmacist described the rash as not itchy but red, and noted it was located on the patient''s chest, legs, arms and back. Treatment included BENADRYL, with a MEDROL DOSE PAK also prescribed. At the time of this report, the pharmacist confirmed the patient was recovering from the rash. Additional information has been requested. This is in follow-up to report (s) previously submitted on 5/14/2007. At the time of this report, the pharmacyst confirmed the patient had recovered (date an duration not specified). No further information is expected.


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