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This is VAERS ID 279504

Case Details

VAERS ID: 279504 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Maryland  
Vaccinated:2007-02-02
Onset:2007-02-02
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:100
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Chest pain, Computerised tomogram normal, Dyspnoea, Electrocardiogram normal, Muscle spasms, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (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: ORTHO TRI-CYCLEN LO
Current Illness: Allergic reaction to antibiotics
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: electrocardiogram, 04/20/07, within normal limits; chest computed axial, 04/20/07, within normal limits
CDC Split Type: WAES0704USA04293

Write-up: Information has been received from an office receptionist concerning a 20 year old female patient with family history of heart disease, allergic reaction to antibiotics, who on 02-FEB-2007 was vaccinated IM with a first dose of Gardasil lot #654741/0013U. Concomitant therapy included Ortho Tri-Cyclean Lo. On 02-FEB-2007 the patient developed arm soreness but otherwise felt fine. On 16-APR-2007, the patient was vaccinated IM with the second dose of Gardasil lot #657621/0387U. Within one to one and half hours after the second injection patient developed muscle spasm in chest area which radiated from left chest to center. She described pain as sharp intermittent and took her breath away. On 18-APR-2007 she took Advil for something else (not specified) and it helped pain a little but was not relieved. The physician instructed patient to go the emergency room (ER). Patient was planning to go to the ER on 19-APR-2007. At the time of this report the patient had not recovered. Additional information has been requested.


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