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This is VAERS ID 278439

Case Details

VAERS ID: 278439 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-05-03
Onset:2007-05-03
   Days after vaccination:0
Submitted: 2007-05-11
   Days after onset:8
Entered: 2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 021OU / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2644AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Acne, Oedema peripheral, Rash, Swollen tongue, Tongue disorder
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: called 05/03/2007 complaining of tongue swelling and rash. Was told to go to emergency room. I called on 05/04/07 for follow up and was told by father that patient was fine, only complained of "tongue heaviness and had a few pimples", did not go to er. Again was called 05/09/2007 when physician not in office, with arm swelling, was told to go to emergency room since there was no physician available for 24 hours to examine patient.


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