| VAERS ID: |
272065 (history) |
| Form: |
Version 1.0 |
| Age: |
21.0 |
| Gender: |
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. |
