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This is VAERS ID 276797

Case Details

VAERS ID: 276797 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: California  
Vaccinated:2007-03-07
Onset:2007-03-11
   Days after vaccination:4
Submitted: 2007-04-18
   Days after onset:37
Entered: 2007-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2002AC / UNK UN / IM
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blister, Chapped lips, Dehydration, Fluid replacement, Injection site erythema, Injection site pain, Injection site swelling, Lip swelling, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: lip culture and blood cultures.
CDC Split Type:

Write-up: pt. received TDAP,HPV,VZV and MENING on 3/7/07. Within a week, one of the injections sites swelled,became painful and red. The doctor''s office was notified of this reaction. Within two weeks of injections, both lips swelled for one day. Within 4 weeks of injection, lips cracked and by the fith week after injection pt was hospitalized for severe stomatitis. Please note, the pt has never suffered these symptoms before, nor has she seeked care for this problem prior to this outbreak. Pt became dehydrated and needed i.v. care. Pt had blister type lesions that started on the outside of the lips and continued to spread to the back of the throat. Pt has improved greatly and should have a full recovery. 6/27/07-records received from facility. Oral lesion, virus culture positive for herpes simplex virus. Blood culture no growth. No documentation to support hospitalization. Stomatitis outhreahs regularly meds needed daily, possibly for life. Altered life illness. The doctor wants her to get the other two shots. I think that is negligent! This shot never should have been given with all the others!


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