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This is VAERS ID 274972

Case Details

VAERS ID: 274972 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: New York  
Vaccinated:2007-01-11
Onset:2007-01-11
   Days after vaccination:0
Submitted: 2007-03-27
   Days after onset:74
Entered: 2007-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest X-ray normal, Chest pain, Electrocardiogram normal, Fibrin D dimer normal
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergy Penicillin
Allergies:
Diagnostic Lab Data: Chest Xray & EKG within normal limit, Dedimer normal
CDC Split Type:

Write-up: Pt received Gardasil vaccine 1/11/07 at 100PM - Developed c/o chest pain late evening & went to hospital ER. Pt brought this to our attention 3/12/07 when she was scheduled for her second vaccination - dose not given. No intervention other than Advil given in ER.


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