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This is VAERS ID 283958

Case Details

VAERS ID: 283958 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Washington  
   Days after vaccination:7
Submitted: 2007-10-08
   Days after onset:258
Entered: 2007-06-18
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Blister, Dysmenorrhoea, Herpes zoster, Local reaction, Pain of skin, Rash erythematous, Scab
SMQs:, Severe cutaneous adverse reactions (broad), 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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Dysmenorrhea
Preexisting Conditions: Hodgkin''s disease; Chemotherapy
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA02730

Write-up: Information has been received from a nurse practitioner concerning a 16 year old female with a history of Hodgkin''s disease (at the age of 12, patient was diagnosed with Hodgkin''s disease and went thru Chemotherapy), who was vaccinated a few weeks ago with Gardasil. The patient developed localized reaction like shingles after getting vaccine. Unspecified medical attention was sought. No additional information was provided. This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a nurse practitioner concerning a 16 year old white female patient with Hodgkin''s disease (diagnosed at age 12 and went through Chemotherapy and illness at time of vaccination included dysmenorrhea) who on 15-JAN-2007 at 12:07, was vaccinated IM with a first 0.5 ml dose of GARDASIL. On 22-JAN-2007, one week after receiving the vaccine, the patient developed painful vesicles which lasted for six weeks. The patient described them as a painful cluster of red bumps that enlarged, blisters erupted followed by crusting over. It was reported that the patient was not seen for eight weeks after the injection and the vesicles were not verified by the staff. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. Subsequently, the patient recovered. No product quality complaint was involved. Additional information is not expected.

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