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This is VAERS ID 274278

Case Details

VAERS ID: 274278 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Missouri  
Vaccinated:2007-02-12
Onset:2007-02-12
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:29
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 2 - / IM

Administered by: Public       Purchased by: Private
Symptoms: Blood pressure fluctuation, Computerised tomogram, Drug administered at inappropriate site, Headache, Hyperventilation, Malaise, Migraine
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Medication errors (narrow)

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: ORTHO TRI-CYCLEN LO, BENADRYL, TYLENOL EXTRA STRENGTH
Current Illness: Bronchitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: head computed axial -
CDC Split Type: WAES0702USA02968

Write-up: Information has been received from a health professional concerning a 15 year old female with no medical history, who on 12-FEB-2007 at 15:30 was vaccinated IM with a second dose of Gardasil (lot# 653978/0955F). Concomitant therapy included ORTHO TRI-CYCLEN LO, BENADRYL and TYLENOL EXTRA STRENGTH. Illness at the time of vaccination included bronchitis. It was noted that the patient may have not eaten all day. "At the patient''s request she received the vaccination in her glut." After 2 to 3 minutes, the patient felt sick and began to hyperventilate. The patient''s blood pressure went up and down and she complained of a left-sided headache. The patient was diagnosed with a migraine. It was noted that the patient was sent to the emergency room. A "CT of her head" was performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.


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