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This is VAERS ID 283939

Case Details

VAERS ID: 283939 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Submitted: 2007-06-14
   Days after onset:118
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Biopsy skin, Vasculitis
SMQs:, Vasculitis (narrow)

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: YASMIN
Current Illness: Drug hypersensitivity
Preexisting Conditions: Viral myocarditis
Diagnostic Lab Data: Biopsy ?/?/07 - confirmed subcutaneous vasculitis
CDC Split Type: WAES0705USA02268

Write-up: Information has been received from a physician concerning a 19 year old female with a BACTRIM allergy and a history of viral myocarditis (approximately 2005) who has had doses of Gardasil. Concomitant therapy included YASMIN. On 15-FEB-2007 the patient experienced subcutaneous vasculitis. A biopsy was performed which confirmed the subcutaneous vasculitis. The physician noted the two dosed of vaccine were administered at another facility so she did not have the dated of administration or the lot numbers. The patient''s subcutaneous vasculitis persisted. Additional information has been requested.

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