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This is VAERS ID 283953

Case Details

VAERS ID: 283953 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Louisiana  
Vaccinated:2007-03-22
Onset:2007-03-22
   Days after vaccination:0
Submitted: 2007-10-08
   Days after onset:200
Entered: 2007-06-18
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0314U / 1 GM / IM

Administered by: Private       Purchased by: Private
Symptoms: Photosensitivity reaction, Rash erythematous, Rash morbilliform, Seasonal allergy
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Conjunctival disorders (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Seasonal allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA02662

Write-up: Information has been received from a physician concerning a 12 year old female who on 22-MAR-2007 was vaccinated with Gardasil (lot# 657005/0314U). On 23-MAR-2007 the patient experienced diffuse erythematous rash upper and lower extremities. The patient sought medical attention on 26-MAR-2007 and was prescribed ZYRTEC. Subsequently, the patient recovered from diffuse erythematous rash upper and lower extremities. Additional information has been requested. Initial and follow up information has been received from a physician and a physician''s assistant, concerning a 12 year old white female student with seasonal allergies, and no illnesses at the time of vaccination, who on 22-MAR-2007, at 9:00am, was vaccinated in the left gluteus maximus, with the first dose of GARDASIL (lot# 657005/0314U). On 23-MAR-2007, at 1:00pm, the patient experienced a morbilliform rash, also described as a diffuse erythematous rash, on the upper and lower extremities. The PA confirmed that the rash worsened when exposed to sunlight, but involved no itching. The patient sought medical attention on 26-MAR-2007 and was prescribed ZYRTEC. No laboratory diagnostic studies were performed. On 28-MAR-2007, the patient recovered from the morbilliform rash. On 21-MAY-2007, at 4:30pm, the patient was vaccinated in the right gluteus maximus, with the second dose of GARDASIL (lot# 657005/0314U). No further information is expected.


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