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This is VAERS ID 266371

(NOTE: This result is from the 12/30/2006 version of the VAERS database)

Case Details

VAERS ID: 266371 (history)  
Form: Version .0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2006-10-03
Onset:2006-10-06
   Days after vaccination:3
Submitted: 2006-11-06
   Days after onset:31
Entered: 2006-11-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0702F / 0 UN / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho Tri Cyclen LO
Current Illness:
Preexisting Conditions: Hypersensitivity.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Information has been received from a physician and the mother of a 15 year old female with a history of hypersensitivity reactions to allergens. On 10/3/06, the pt was vaccinated IM with the first dose of 0.5ml of HPV vaccine (lot 653650/0702F. Concomitan"t therapy included Ortho Tri Cyclen LO started on 10/6/06. On 10/06/06, the pt developed widespread itching and hives of both upper and lower extremities. The pt did not experience respiratory symptoms. The pt was self treated with Benadryl with only mild


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