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This is VAERS ID 279046

Case Details

VAERS ID: 279046 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2007-03-28
Onset:2007-03-30
   Days after vaccination:2
Submitted: 2007-05-14
   Days after onset:45
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 1 UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest discomfort, Chills, Cough, Dizziness, Pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (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: none
Current Illness: Penicillin allergy
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: none
CDC Split Type: WAES0704USA00424

Write-up: This is in follow-up to report (s) previously submitted on 5/14/2007. Information has been received from a certified medical assistant concerning a 25 year old female with no pertinent medical history and with penicillin allergy (nausea, vomiting and hives at age 5) who on 28-MAR-2007, was vaccinated with first dose of Gardasil (Lot#655618/0186U). There was no concomitant medication. On 30-MAR-2007, the patient developed widespread body aches, chills and dizziness two days after receiving the vaccine. When she took a deep breath she experienced coughing that lasted a few seconds and some tightness. On 31-MAR-2007, within 24 hours, (at 12:00 noon), the patient recovered from widespread body aches, chills, coughing, tightness and dizziness without treatment. The patient sought unspecified medical attention. Additional information is not expected.


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