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This is VAERS ID 283732

Case Details

VAERS ID: 283732 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: New York  
   Days after vaccination:2
Submitted: 2007-06-14
   Days after onset:95
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Urticaria
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Sulfonamide allergy
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA03940

Write-up: Information has been received from a registered nurse in a physician''s office concerning a 20 year old patient with an allergy to sulfamethoxazole (+) trimethoprim who on 08-MAR-2007 was vaccinated with a first dose of Gardasil (lot # 655618/0186U) in the left deltoid at 11:00 AM. The nurse reported that the patient had received the second dose late (second dose was given on "01-OCT-2007"). No adverse experience is related to this event. No other information was available at the time of reporting. Additional information was received. Conflicting information was received regarding the number of doses of vaccine that the patient had received. The reporter indicated that this was the first dose of vaccine. On 10-MAR-2007, the patient experienced hives. On an unspecified date, the patient recovered. The reporter felt that the hives were serious medical intervention was required (Other Important Medical Event). No additional information is expected.

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