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This is VAERS ID 284343

Case Details

VAERS ID: 284343 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-07-11
Entered: 2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Pruritus, 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Alg: Soy, Miralax
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: w/in 2 days pt developed small, red, itchy, raised rash to both arms.


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