National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 284170

Case Details

VAERS ID: 284170 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: California  
   Days after vaccination:2
Submitted: 2007-06-14
   Days after onset:28
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Private
Symptoms: No reaction on previous exposure to drug, 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: hormonal contraceptives
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA03913

Write-up: This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a physician concerning an 18 year old female with unspecified allergies and acne and a history of chickenpox and eczema, who on 15-MAY-2007 at 17:25 was vaccinated IM into the left deltoid with a second 0.5 ml dose of GARDASIL (lot# 657736/0389U). Concomitant therapy included hormonal contraceptives (unspecified). On 17-MAY-2007, the patient developed a small fine rash. It was reported that on 15-MAR-2007, the patient received a first dose of Gardasil and did not experience any adverse event. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.

New Search

Link To This Search Result:

Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166