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This is VAERS ID 283978

Case Details

VAERS ID: 283978 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-04-01
Onset:2007-04-01
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:74
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 RA / IM

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
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: Unknown
Current Illness: Penicillin allergy: Allergic reaction to antibiotics
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA03012

Write-up: Information has been received from a registered nurse concerning a female under 18 years old who in approximately April 2007 was vaccinated with the first dose of Gardasil. Subsequently the patient experienced a rash on her complete torso. The patient was prescribed an unknown cream as treatment. The rash did not resolve by 5 days but may have resolved by now. Medical attention was sought. Additional information has been requested. This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a registered nurse concerning a 15 year old female student with PENICILLIN, AMOXICILLIN and CECLOR allergies who on 19-APR-2007 at 16:23 was vaccinated intramuscularly into the right deltoid with the first dose of GARDASIL (Lot # 654702/0011U). On 22-APR-2007, the patient felt "cold and achy" which persisted until the p.m. of 23-APR-2007 when itchiness and a rash on her complete torso, knees and back of hands developed. The patient was prescribed CLARINEX and LOTRISONE cream as treatment. The rash did not resolve by 5 days. The patient''s mom called on 01-MAY-2007 and reported that the symptoms persisted. No further information had been received since then. Additional information is not expected.


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