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This is VAERS ID 279252

Case Details

VAERS ID: 279252 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:0
Submitted: 2007-05-21
   Days after onset:38
Entered: 2007-05-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Dysphagia, Dyspnoea, Pallor, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)

Life Threatening? Yes
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:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA03002

Write-up: Information has been received from a nurse practitioner concerning a 15 year old female with no pertinent medical history or history of drug reactions/allergies, who on 13-APR-2007 was vaccinated with the first dose of Gardasil, 0.5 ml, IM, right deltoid (lot # 653978/0955F). There was no concomitant medication. The patient was in the waiting room for 5 to 10 minutes post injection when she experienced loss of coloration and had difficulty breathing and swallowing. The patient felt like her throat was closing up. The patient was administered an EPI (epinephrine) injection and stayed in the office for 45 minutes. The events improved after the epinephrine injection and was considered to have recovered from loss of coloration, difficulty breathing, difficulty swallowing and throat closing up. The nurse practitioner considered the events to be an other important medical events and to be life threatening. Additional information has been requested.

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