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This is VAERS ID 307686

Case Details

VAERS ID: 307686 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: New York  
   Days after vaccination:6
Submitted: 2008-03-14
   Days after onset:41
Entered: 2008-03-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Blister, Mouth ulceration, No reaction on previous exposure to drug, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0802USA03079

Write-up: Information has been received from a consumer concerning her 17 year old daughter who on 11-JUL-2007, 20-SEP-2007, 26-JAN-2008 was vaccinated with her first, second and third dose of Gardasil, respectively. It was reported that the patient did not have a reaction to the first or second dose. Within two weeks after her third dose she experienced a high fever and blisters down her throat. It was reported that she missed work and school due to the reaction. The consumer''s sister also had a similar reaction to Gardasil (WAES#0710USA03615). Additional information has been requested. follow up 2/12/2010- follow up information received from the physician regarding a 14 year old caucasian female patient (previously reported as 17 years old) with no previous medical history or no illness at the time of vaccination, who on 11-jul-2007. at 10:04 am was vaccinated IM in the left arm with the first dose of HPV 6 11 16 18 vaccine (yeast) (lot# 658100/05250) and on 20-sep-2007 at 6: 46 pm, was vaccinated IM in the left arm with the second dose of HPV 11 16 18 vlp vaccine (yeast) lot# 657736/0389u. on 31-jul-2007, the patient experienced a fever began 2 weeks following the 1st vaccination. also experienced oral ulcers. fever persisted x 1 week. again developed fever and mouth sores 2 weeks following dose 2. no reactions after the third vaccination. the patient recovered 1-2 weeks after onset of symptoms.

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