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This is VAERS ID 279252

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279252
VAERS Form:
Age:15.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-05-21
Entered:2007-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Dysphagia, Dyspnoea, Pallor, Throat tightness

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

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 clo


Changed on 12/8/2009

279252 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-05-21
Entered:2007-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dysphagia, Dyspnoea, Pallor, Throat tightness

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': (blank) 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 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 clo 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.


Changed on 9/14/2017

279252 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-05-21
Entered:2007-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Dysphagia, Dyspnoea, Pallor, Throat tightness

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=279252&WAYBACKHISTORY=ON


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