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This is VAERS ID 279501

Case Details

VAERS ID: 279501 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-03-28
Onset:2007-04-03
   Days after vaccination:6
Submitted: 2007-05-14
   Days after onset:41
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Rash
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0704USA04279

Write-up: Information has been received from a physician concerning a 13 year old female with a history of eczema who in April 2007, was vaccinated with Gardasil. In April 2007, within 24 hours later after receiving the vaccine, the patient experienced a rash behind her knee. It was reported that the patient sought unspecified medical attention. No further information was provided. Additional information has been requested. 10/08/07 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 concerning a 17 year old female with a history of eczema who on 28-MAR-2007 at 10:45 am was vaccinated intramuscularly into the left deltoid with the first dose of the GARDASIL (Lot # 657006/0188U). On approximately 03-APR-2007, within 24 hours after receiving the vaccine (also reported as one week after vaccination), the patient developed an eczema-like rash behind her knee. It was reported that the patient sought unspecified medical attention. There were no laboratory or diagnostic tests performed. The patient recovered on an unspecified date. This is a consolidation of two reports. Additional information is not expected.


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