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This is VAERS ID 279242

Case Details

VAERS ID: 279242 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Connecticut  
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:83
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0704USA03658

Write-up: This is in follow-up to report (s) previously submitted on 5/14/2007. Information has been received from a healthcare worker concerning a 15 year old female with no pertinent medical history or drug reactions/allergies, who on 19-FEB-2007 was vaccinated intramuscularly with GARDASIL. There was no concomitant medication. On 19-FEB-2007, with a few hours of receiving the vaccine, the patient developed hives. Unspecified medical attention was sought, and the patient took BENADRYL for the symptoms. The hives subsequently resolved. Additional information has been requested. No further information is expected.

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