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This is VAERS ID 279266

Case Details

VAERS ID: 279266 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Illinois  
Vaccinated:2007-05-03
Onset:2007-05-04
   Days after vaccination:1
Submitted: 2007-05-09
   Days after onset:5
Entered: 2007-05-22
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1425F / 1 LA / IM

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

Write-up: Received Gardasil on 5-3-07. Also was provided prescription for Elimite cream. Cream applied on the pm of 5-3-07. Child awoke w/diffuse hives on 5-4-07.


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