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This is VAERS ID 274470

Case Details

VAERS ID: 274470 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: New York  
Vaccinated:2007-03-13
Onset:2007-03-13
   Days after vaccination:0
Submitted: 2007-03-15
   Days after onset:2
Entered: 2007-03-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1967AA / 1 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2456AA / 5 RA / UN

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain, Chest discomfort, Neck pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest X-ray, 03/13?/07
CDC Split Type:

Write-up: Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol. This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a registered nurse and a licensed practical nurse concerning a 12 year old female student with no pertinent medical history who on 13-MAR-2007, at 16:45 was vaccinated, intramuscularly into the left arm, with a 0.5 mlm first dose of GARDASIL (lot #655618/0186U) concomitantly with a first dose of MENACTRA (lot #0167AA) and a fifth dose of ADACEL (lot #C2456AA) into the right arm. On 13-MAR-2007, at 17:45 (also, reported as 2 hours after vaccination), the patient developed severe arm and neck pain, chest tightness and abdominal pain. At bedtime, the patient had difficulty breathing and pain in her chest. Her mother took her to the emergency room where she had a chest x-ray. It was reported that there was no detection of wheezing, swelling or pulmonary embolism. She was treated with albuterol which "did not seem to help." As of 14-MAR-2007, the patient was improving her arm and chest were "just sore." No further information is available.


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