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This is VAERS ID 279563

Case Details

VAERS ID: 279563 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Colorado  
Vaccinated:2007-03-29
Onset:2007-04-19
   Days after vaccination:21
Submitted: 2007-05-14
   Days after onset:25
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Rash erythematous, Rash maculo-papular, Rash pustular
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA05797

Write-up: Initial and follow up information has been received from a physician and a health care professional concerning a 19 year old white female student who on 29-MAR-2007 at 1:00 pm was vaccinated IM in the left deltoid with a first dose of Gardasil. The physician reported after receiving the injection the patient developed "small red bumps and pustules behind her ears and along her neck." Follow up report came from a healthcare professional and it was reported that on 19-APR-2007 at 8:00 am the patient had fine, red, non-itchy maculo papular rash behind both ears/thighs. She was treated with prescription medication. The outcome was unknown. Additional information is not expected.


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