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This is VAERS ID 282553

Case Details

VAERS ID: 282553 (history)  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2006-12-28
Onset:2007-01-01
   Days after vaccination:4
Submitted: 2007-05-25
   Days after onset:143
Entered: 2007-06-06
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / 0 UN / UN

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
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic reaction to antibiotics
Preexisting Conditions: Rash
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0702USA00964

Write-up: Initial information has been received from a nurse practitioner concerning a 19 year old, female, who reportedly developed a rash with Ceclor, whose reported weight was 175 pounds (lbs) and whose reported height was 66 and 1/2 inches (in), who had no illness at the time of vaccination, who on 15-DEC-2006 was vaccinated intramuscularly, into the arm with her first dose of Gardasil, (lot # 653978/0955F), (WAES # 0701USA00254). On 28-DEC-2006 (also reported as 28-DEC-2007), the patient was vaccinated into the left arm with hepatitis A virus vaccine inactivated (Lot # AHAUB1Y1AA), (manufacturer unknown). It was reported that on 01-JAN-2007, the patient developed hives and rash on chest. At the time of report it was unknown if the patient recovered. Additional information has been requested.


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