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This is VAERS ID 283962

Case Details

VAERS ID: 283962 (history)  
Age: 17.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-03-14
Onset:2007-03-14
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:92
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA02886

Write-up: Information has been received from a physician, via a company representative, concerning a 17 year old female patient, who on approximately 14-MAR-2007 ("approximately 2 months ago"), was vaccinated with the first dose of Gardasil (dose not specified). The day following the vaccination, the patient called the physician to report she had developed a rash on her arm, though not at the injection site, as well as on other parts of her body. The patient presented to the office 2 or 3 days later, and a cream (unspecified) was prescribed as treatment. At the time of this report, it wan unknown if the patient had recovered from the rash. Additional information has been requested.


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