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This is VAERS ID 283783

Case Details

VAERS ID: 283783 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Washington  
   Days after vaccination:19
Submitted: 2007-06-14
   Days after onset:54
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Skin lesion, Throat irritation, Treponema test negative
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Ortho Tri-Cyclen; Effexor
Current Illness: Penicillin allergy
Preexisting Conditions: Penicillin allergy
Diagnostic Lab Data: Rapid plasma reagin card, negative
CDC Split Type: WAES0705USA01517

Write-up: Information has been received from a nurse practitioner concerning a 17 year old female with allergies to penicillin and amoxicillin who on 02-APR-2007 was vaccinated IM with a second dose of 0.5 ml of Gardasil (Lot # 654702/0011U). Concomitant therapy included EFFEXOR and ORTHO TRI-CYCLEN. On 21-APR-2007, the patient experienced an itchy throat without respiratory distress, but did not seek medical attention. On 01-MAY-2007, the patient was seen by the nurse practitioner who described the circular lesions. 04-MAY-2007, the patient developed lesions, which manifested as circular with white spots, on her hands and at the achilles tendon of the feet after she received the second dose of Gardasil No fever was noted. The "target" appearance resolved in three days. On an unspecified date, a rapid plasma reagin card test was performed, the result of which was negative. The patient outcome was unknown. Additional information has been requested. Additional infromation is not expected.

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