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This is VAERS ID 284900

Case Details

VAERS ID: 284900 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: West Virginia  
   Days after vaccination:1
Submitted: 2007-07-06
   Days after onset:37
Entered: 2007-07-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Epstein-Barr virus antibody negative, Epstein-Barr virus infection, Rash generalised, Rash pruritic
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: None
Current Illness: Eye pain; Fatigue; Upper respiratory tract infection; Penicillin allergy
Preexisting Conditions:
Diagnostic Lab Data: Epstein-Barr virus - convalescencing
CDC Split Type: WAES0706USA00208

Write-up: Information has been received from a physician concerning a 13 year old female with penicillin allergy who on 29-MAY-2007 was vaccinated IM with 0.5 ml of the first dose of Gardasil (Lot #654702/0011U). There was no concomitant medication. On 30-MAY-2007 the patient experienced an all over body rash with itching. Prior to the injection, the patient complained of her eyes hurting, an upper respiratory infection, and fatigue. The patient did not have a fever. The physician performed an Epstein-Barr titer that came back with a result of "convalescencing". The patient was given Depo-Medrol on 30-MAY-2007 and Garamycin ointment for her eye. As of 01-JUN-2007, the patient was recovering. Medical attention was sought. Additional information has been requested.

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