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This is VAERS ID 279511

Case Details

VAERS ID: 279511 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:4
Submitted: 2007-05-14
   Days after onset:28
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Exposure to communicable disease, Urticaria, Varicella
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: BOOSTRIX
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA04485

Write-up: Information has been received from a nurse practitioner (NP), via a company representative, concerning an 11 year old female who on 12-APR-2007 was vaccinated with the second dose Gardasil. Concomitant therapy included Boostrix. On 16-APR-2007 the patient experienced intermittent hives that look like tiny pimples that are not itchy. The event persisted as of 20-APR-2007. Follow up information from the NP, via the company representative, confirmed that the patient''s hives/rash was "diagnosed as a case of chicken pox." The NP stated that there was an outbreak in the patient''s school district. At the time of this report, the patient had not recovered from the chicken pox. The patient sought unspecified medical attention. Additional information has been requested.

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