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This is VAERS ID 279622

Case Details

VAERS ID: 279622 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-02-22
Onset:2007-02-22
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:80
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 AR / IM

Administered by: Other       Purchased by: Other
Symptoms: Rash generalised, Vaccine positive rechallenge
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:
CDC Split Type: WAES0704USA06044

Write-up: Information has been received from a health professional concerning a 19 year old female who on 22-FEB-2007 was vaccinated, in the deltoid, with Gardasil. On 22-FEB-2007 the patient experienced mild rash all over her body. On 23-APR-2007 the patient was vaccinated with her second dose, IM injection in the right deltoid and developed a severe rash all over body. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 5/14/2007. It was reported that the physician "did not administer the vaccine and does not have any follow up information to provide". Additional information is not available.


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