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This is VAERS ID 279494

Case Details

VAERS ID: 279494 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-02-06
Onset:2007-02-06
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:96
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Pain
SMQs:

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: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0704USA04098

Write-up: Information has been received from a pharmacist concerning her daughter, a 14 year old female with an amoxicillin allergy who on 06-FEB-2007 was vaccinated with Gardasil. Concomitant therapy included hepatitis B virus vaccine (unspecified) in the other arm. On 06-FEB-2007, at the time of administration, the patient experienced severe pain. The patient sought unspecified medical attention. On 07-FEB-20074, after a day, the patient recovered from severe pain. Additional information is not expected.


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