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This is VAERS ID 279516

Case Details

VAERS ID: 279516 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-04-21
Onset:2007-04-21
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:23
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: albuterol, SINGULAIR
Current Illness: Asthma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA05060

Write-up: Initial and follow up information has been received from a Certified Registered Nurse Practitioner (CRNP) concerning a 16 year old female student with asthma who on 21-APR-2007 at 9:30 AM was vaccinated IM with a first dose of Gardasil (lot #0210U not valid). Concomitant therapy included montelukast sodium and albuterol over the counter (OTC)-10. On 21-APR-2007 at 5:00PM the patient developed exacerbation of asthma with activity during two basketball games one at 5:00PM and one at 8:00PM. She used albuterol 7 times during the basketball game. Normally she didn''t need to use the albuterol that many times. On 22-APR-2007 the patient recovered in the AM. Additional information is not expected.


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