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This is VAERS ID 278026

Case Details

VAERS ID: 278026 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-02-15
Onset:2007-04-05
   Days after vaccination:49
Submitted: 2007-04-30
   Days after onset:25
Entered: 2007-05-07
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / UNK UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / UNK UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1922A / UNK UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2631A / UNK UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of no known allergies. She has the Fluzone vaccine annually.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200701400

Write-up: Hives, cluster of 2 patients (patient identification provided) with generalized hives throughout the entire body, after receiving Adacel (lot number C2631AA); Fluzone (lot number unknown), and Menactra (lot number U1922AB), received from a health care professional in the USA on 24 April 2007. Case 1: An 11 year old, female patient ( with a history of no known allergies) developed generalized hives throughout the entire body, 1.1/2 months after she received Adacel (lot number C2631AA); Fluzone (lot number unknown), and Menactra (lot number U1922AB) and Gardasil (Merck, lot number 0014U ) on the 15 February 2007. She has the Fluzone vaccine annually. The patient denies any illness or medications at the time of the vaccinations. She was treated with Cortisone, Singulair and Atarax. It was reported the hives resolved and the patient recovered. The second case (the patient ''s brother ) is detailed in case 2007-01399.


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