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This is VAERS ID 275734

Case Details

VAERS ID: 275734 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Maryland  
Vaccinated:2007-04-03
Onset:2007-04-03
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:3
Entered: 2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 1 RA / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chromatopsia, Dyspnoea, Hypotension, Injection site pain, Oral pain, Pharyngolaryngeal pain, Photopsia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (narrow)

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: Previous reaction to DPT vaccine (seizure)Previous reaction to dental sealants (multiple canker sores, unexplained muscle twitching, rash on trunk of body)Previous reaction to sulfa based eye drops prescribed for pinkeye
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within one minute following injections, patient experienced flashing lights in her eye; could only see in bright primary colors; had extreme trouble breathing; experienced pain in top of mouth and throat; pain at injection site; blood pressure was low. Symptoms started to subside after injection of Epinephrine and use of Nebulizer. She has no history of food or pollen allergies.


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