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This is VAERS ID 284158

Case Details

VAERS ID: 284158 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-05-10
Onset:2007-05-10
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:35
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Colonoscopy, Dizziness, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (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:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: colonoscopy 05/11/07
CDC Split Type: WAES0705USA03794

Write-up: Information has been received from a nurse practitioner concerning a 17 year old female patient who on 10-MAY-2007 was vaccinated with a dose of Gardasil. On 10-MAY-2007 the patient experienced a rash on her legs and dizziness. The day after she developed a rash on her arms. The patient also had a colonoscopy performed on that day. Unspecified medical attention was sought. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.


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