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This is VAERS ID 277413

Case Details

VAERS ID: 277413 (history)  
Form: Version 1.0  
Age:   
Gender: Unknown  
Location: Missouri  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2007-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2208AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C26900AA / 6 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1250F / 2 LA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Anaphylactic reaction, Dyspnoea, Rash, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anaphylaxis, rash, wheezing, mild difficulty breathing. Recovered completely with steroids, Benadryl, etc. Has since had second Gardasil, no problems.


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