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This is VAERS ID 283737

Case Details

VAERS ID: 283737 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: New Jersey  
   Days after vaccination:3
Submitted: 2007-06-14
   Days after onset:47
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Rash pruritic
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amoxicillin; hormonal contraceptives
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0705USA00465

Write-up: Information has been received from a registered nurse concerning a 19 year old female with pertinent medical history and drug reactions/allergies reported as none who on 25-APR-2007 was vaccinated with the first dose of Gardasil (lot #657621/03857U), 0.5 ml, IM. Concomitant therapy included amoxicillin and hormonal contraceptives (unspecified). On approximately 28-APR-2007 or 29-APR-2007 (nurse was not sure which date), the following weekend, the patient developed an itchy rash. The rash developed first on the patient''s arms and then on her legs. The patient sought unspecified medical attention. The patient took BENADRYL for the symptoms. There has been no improvement so the patient will be seeing a dermatologist. Additional information has been requested.

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