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This is VAERS ID 284142

Case Details

VAERS ID: 284142 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Colorado  
Vaccinated:2006-10-20
Onset:2007-01-08
   Days after vaccination:80
Submitted: 2007-06-14
   Days after onset:156
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Pharyngitis, Streptococcus identification test negative, Viral pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (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: albuterol, SINGULAIR
Current Illness:
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Streptococcus oralis, 01/08/07, stret test and culture negative
CDC Split Type: WAES0705USA03261

Write-up: Information has been received from a medical assistant concerning a 13 year old female patient with an amoxicillin allergy and no medical history, who on 20-OCT-2006 was vaccinated IM into the upper arm with a first dose of Gardasil (Lot# 653978/0955F). Concomitant therapy included montelukast sodium (MSD) and albuterol. It was reported that the patient got off the recommended dosing schedule because she was sick. On 05-JAN-2007 the patient was diagnosed with pharyngitis (likely viral). The patient was told to take zinc and homeopathic medicine called "INFLAMMATION by Heal." On 08-JAN-2007, laboratory diagnostic studies included a strep test and culture that was negative. On 12-JAN-2007, the patient was seen again and was diagnosed with pharyngitis and a possible ear infection and was given a homeopathic medicine called ("EUPHORIM"), a nasal spray. On 01-FEB-2007 the patient came in for a second dose of the vaccine (lot # 654702/0011U). It was reported that the patient no longer had an infection and subsequently recovered. No product quality complaint was involved. Additional information has been requested.


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