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This is VAERS ID 151822

Case Details

VAERS ID: 151822 (history)  
Form: Version 1.0  
Age: 45.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2000-01-11
Onset:2000-01-12
   Days after vaccination:1
Submitted: 2000-04-21
   Days after onset:99
Entered: 2000-05-10
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Face oedema, 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? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000010851

Write-up: On 1/11/00, the pt received her first IM dose of Lymerix. On 1/12/00 AM the pt developed hives on her face with itching and swelling. Applying baking soda to her face decreased the itching and the swelling. The most recent information received on on 1/12/00 reports the condition of the pt is improving.


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