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This is VAERS ID 283935

Case Details

VAERS ID: 283935 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2007-05-09
Onset:2007-05-09
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:36
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Unknown
Current Illness: Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA02203

Write-up: Information has been received from a physician concerning a 16 year old female with an unspecified drug allergy who on 09-MAY-2007 was vaccinated IM with the first dose of Gardasil. Within an hour, the patient experienced shortness of breath and possibly hives. The physician sent the patient to the ER. Additional information has been requested.


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