VAERS ID: |
272065 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 2007-02-07 |
Onset: | 2007-02-07 |
Days after vaccination: | 0 |
Submitted: |
2007-02-09 |
Days after onset: | 2 |
Entered: |
2007-02-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0012U / 1 |
LA / IM |
Administered by: Other Purchased by: Private Symptoms: Blood glucose normal,
Body temperature decreased,
Dizziness,
Dyspnoea,
Headache,
Heart rate increased,
Oxygen saturation SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (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: NONE Current Illness: NONE per patient Preexisting Conditions: ASTHMA Allergies: Diagnostic Lab Data: blood glucose 86 mg/dl, temperature 97.1, pulse 88 and regular, BP 110/76 SpO2 99% CDC Split Type:
Write-up: Headachem dizziness, increased heart rate, light-headness, shortness of breath. Symptoms began approximately 40 minutes after vaccination. |