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This is VAERS ID 279521

Case Details

VAERS ID: 279521 (history)  
Age: 17.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-04-17
Onset:2007-04-18
   Days after vaccination:1
Submitted: 2007-05-14
   Days after onset:26
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Injection site rash, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: YASMIN
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA04634

Write-up: Initial and follow up information has been received from a nurse practitioner (NP)/ certified nurse midwife, and a nurse, concerning a 17 year old caucasionr female patient, who on 17-APR-2007, at 3:30pm was vaccinated IM in the left deltoid with the first dose of Gardasil (Lot #657617/0384U). Concomitant therapy included Yasmin. There was no known illness at the time of vaccination. The nurse practitioner reported that 18-APR-2007, (previously reported by the nurse as on the same day, 17-APR-2007), the patient developed a rash on the left arm (the arm of injection), which later spread to both arms; the rash was described as "redness with urticarial raised patches." The nurse added that the patient also developed a fever. At the time of this report, the NP confirmed that the patient had recovered from the rash and fever (date unspecified). The patient sought unspecified medical attention. No further information is expected. Additional information has been requested.


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