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This is VAERS ID 282801

Case Details

VAERS ID: 282801 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Nevada  
Vaccinated:2007-05-30
Onset:2007-05-30
   Days after vaccination:0
Submitted: 2007-06-25
   Days after onset:26
Entered: 2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. U2114AA / 1 LA / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Muscle twitching, Rash macular, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dyskinesia (broad), Dystonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blotchy rash and puffiness on face, muscle twitching face, arms, legs, felt tight, twitching feeling and tightness resolved with Benadryl all Sx resided with in 2 days.


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