|
VAERS ID: |
266371 (history) |
Form: |
Version 1.0 |
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: HPV (GARDASIL) / MERCK & CO. INC. |
0702F / 1 |
UN / IM |
Administered by: Other Purchased by: Other Symptoms: Pruritus,
Urticaria 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? 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: WAES0610USA14679
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. Concomitant 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 improvement. A nurse in the local ER was consultated by phone but the pt did not require hospitalization. The symptoms resolved after one week and the pt had not experienced further problems. On 10/13/06 the pt had recovered from the event. The physician considered the event to be serious as disabling. Additional information has been requested. |
|
VAERS ID: |
266497 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Indiana |
Vaccinated: | 2006-10-30 |
Onset: | 2006-10-30 |
Days after vaccination: | 0 |
Submitted: |
2006-11-10 |
Days after onset: | 11 |
Entered: |
2006-11-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / 1 |
LA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Disorientation,
Dizziness,
Dyspnoea,
Nausea,
Syncope,
Syncope vasovagal SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (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: Advil, Benadryl, Tylenol Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Patient fainted in waiting area less than five minutes after receiving Gardasil injection. Patient disoriented and c/o difficulty breathing when roused. C/O nausea, dizziness. Sent to ER & diagnosed as vasovagal syncope. Patient c/o sores in genital area 3 days post vaccination. Upon visit to doctor, diagnosed with Condyloma. |
|
VAERS ID: |
266541 (history) |
Form: |
Version 1.0 |
Age: |
14.0 |
Sex: |
Female |
Location: |
Kentucky |
Vaccinated: | 2006-09-13 |
Onset: | 2006-09-14 |
Days after vaccination: | 1 |
Submitted: |
2006-11-10 |
Days after onset: | 57 |
Entered: |
2006-11-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0702P / 1 |
RA / - |
Administered by: Private Purchased by: Private Symptoms: Angioneurotic oedema,
Face oedema SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: Angioedema lips for one month by history from pt. |
|
VAERS ID: |
266568 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Female |
Location: |
West Virginia |
Vaccinated: | 2006-10-25 |
Onset: | 2006-10-25 |
Days after vaccination: | 0 |
Submitted: |
2006-11-01 |
Days after onset: | 7 |
Entered: |
2006-11-13 |
Days after submission: | 12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0955F / 2 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Irritability,
Rash SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: Fussy body rash X 24 hours following vaccination. Cleared spontaneously. |
|
VAERS ID: |
266581 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Female |
Location: |
Virginia |
Vaccinated: | 2006-10-13 |
Onset: | 2006-10-13 |
Days after vaccination: | 0 |
Submitted: |
2006-11-08 |
Days after onset: | 26 |
Entered: |
2006-11-13 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
U2165CA / 3 |
RA / IM |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0688F / 1 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Blood pressure decreased,
Bradycardia,
Heart rate irregular SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiac arrhythmia terms, nonspecific (narrow), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever~DTP (no brand name)~1~1.17~In Patient Other Medications: Allegra, Nasolcrom, Acne meds, Bactrim Current Illness: NONE Preexisting Conditions: Acne, allergies to raw peaches, carrot, potatoes, kiwi, apples, cherries. Allergies: Diagnostic Lab Data: Skin prick tested for allergies. CDC Split Type:
Write-up: Vasovagal RXN. Pt HR decreased to 50 and BP decreased. |
|
VAERS ID: |
266592 (history) |
Form: |
Version 1.0 |
Age: |
11.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 2006-10-31 |
Onset: | 2006-11-01 |
Days after vaccination: | 1 |
Submitted: |
2006-11-06 |
Days after onset: | 5 |
Entered: |
2006-11-13 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
U2199AA / 5 |
RA / IM |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0955F / 1 |
RA / IM |
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC52B011CA / 6 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Erythema,
Rash,
Rash papular,
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: None CDC Split Type:
Write-up: Fine red, papular, pruritic rash on 1st and 2nd digits both hands and dorsum both feet. |
|
VAERS ID: |
266639 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Maine |
Vaccinated: | 2006-11-08 |
Onset: | 2006-11-08 |
Days after vaccination: | 0 |
Submitted: |
2006-11-13 |
Days after onset: | 5 |
Entered: |
2006-11-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0688F / 1 |
RA / - |
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U1808AA / 1 |
LA / - |
Administered by: Private Purchased by: Other Symptoms: Erythema,
Swelling,
Tenderness SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), 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: CONCERTA 54mg Current Illness: NONE Preexisting Conditions: Attention-deficit Hyperactivity disorder Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: 10.4 cm X 7.0 cm area of redness. Swelling and tenderness. Complain of burning at site left deltoid. |
|
VAERS ID: |
266717 (history) |
Form: |
Version 1.0 |
Age: |
37.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 2006-09-25 |
Onset: | 2006-09-30 |
Days after vaccination: | 5 |
Submitted: |
0000-00-00 |
Entered: |
2006-11-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0800F / UNK |
- / - |
Administered by: Private Purchased by: Private Symptoms: 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? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: OVCON Current Illness: NONE Preexisting Conditions: Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: Developed rash all over body gradually subsided after few days. |
|
VAERS ID: |
266734 (history) |
Form: |
Version 1.0 |
Age: |
14.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2006-10-03 |
Onset: | 2006-10-06 |
Days after vaccination: | 3 |
Submitted: |
2006-11-09 |
Days after onset: | 34 |
Entered: |
2006-11-14 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0702F / 1 |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Urticaria 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: Hives all over 3 days after injection. No treatment. |
|
VAERS ID: |
266774 (history) |
Form: |
Version 1.0 |
Age: |
20.0 |
Sex: |
Female |
Location: |
Louisiana |
Vaccinated: | 2006-10-12 |
Onset: | 2006-10-19 |
Days after vaccination: | 7 |
Submitted: |
2006-11-14 |
Days after onset: | 26 |
Entered: |
2006-11-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
08668F / 1 |
LA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Injection site pain,
Shoulder pain SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (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: Yaz, Zoloft, Bactrim DS Current Illness: None Preexisting Conditions: Depression Allergies: Diagnostic Lab Data: none CDC Split Type:
Write-up: Patient developed left shoulder pain at the deltoid corresponding to the site of injection. This began about 1 week after injection and has lasted for 3 weeks. It is 7/10 in severity and requires anti-inflammatories. |
|