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This is VAERS ID 284893

Case Details

VAERS ID: 284893 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:2007-04-02
Onset:2007-04-02
   Days after vaccination:0
Submitted: 2007-07-06
   Days after onset:95
Entered: 2007-07-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 1 UN / IM

Administered by: Private       Purchased by: Public
Symptoms: Eye pruritus, Eye swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (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: Unknown
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA02535

Write-up: Initial and follow up information has been received from a physician concerning a 14 year old female student with possible penicillin allergy who on 02-APR-2007 was vaccinated IM with a first dose 0.5 mL of Gardasil lot # 655205/1426F. On 02-APR-2007 the patient developed swollen eyes after receiving the injection. On 03-APR-2007 the patient was seen in the emergency room (E.R.) for swollen eyes and itching and was given BENADRYL intravenous (IV) and ATERAX by mouth (PO). No abnormality of the eye found. On 05-APR-2007 the patient recovered. In follow up it was indicated that on 03-APR-2007, at AM patient developed swollen eyes and itching. She was seen in the emergency room (E.R.) on 03 APR-2007 and no abnormality of the eyes found. She was given treatment of BENADRYL intravenous (IV) and ATERAX by mouth. On 05-APR-2007 patient recovered. Additional information is not expected.


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