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This is VAERS ID 279509

Case Details

VAERS ID: 279509 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: California  
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:26
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Rash, 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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA04418

Write-up: Information has been received from a physician concerning a 17 year old female patient who on 02-FEB-2007 was vaccinated with a first dose of Gardasil. On 18-APR-2007 she was vaccinated with a second dose of Gardasil (lot #654702/0011U) 0.5 ml. On 18-APR-2007, the patient developed a rash (site unknown) and hives. She was sent to Urgent care center. Patient would not receive the third dose of Gardasil based on her experience with the second injection. The outcome of the event was unknown. Additional information was received from the office manager who reported that the patient was not seen in thier office. The rash was reported by way of the patient''s father. He was told that his daughter should go to an urgent care facility to be seen. The office did not receive a call back nor a report. No additional information is available.

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