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This is VAERS ID 283950

Case Details

VAERS ID: 283950 (history)  
Age: 15.0  
Gender: Female  
Location: Idaho  
Vaccinated:2007-02-27
Onset:2007-02-28
   Days after vaccination:1
Submitted: 2007-06-14
   Days after onset:105
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 0 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2135AA / 0 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood alkaline phosphatase, Blood chloride decreased, Blood potassium normal, Blood sodium normal, Diarrhoea, Dizziness, Pain, Pyrexia, Red blood cell count normal, Vomiting, White blood cell count
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: diagnostic laboratory 03/05/07; arterial blood total 03/05/07 31.7; red blood cell count 03/05/07 5.10; serum alkaline 03/05/07 55; serum chloride 03/05/07 97; serum potassium 03/05/07 3.6; serum sodium 03/05/07 140; WBC count 03/05/07 5.2
CDC Split Type: WAES0705USA02601

Write-up: Information has been received from a health professional concerning a 15 year old white female student who on 27-FEB-2007 was vaccinated in the right deltoid with Gardasil (lot # 655503/0012U) concomitantly with a dose of MENACTRA (lot # U2135AA) in the left deltoid. On 28-FEB-2007 the patient experienced "achey and sore all over", vomiting, dizzy, fever and diarrhea. On 05-MAR-207 the patient was seen in the doctors office and the family nurse practitioner prescribed PHENERGAN TABLETS/SUPPOSITORIES and diagnostic laboratory tests were performed. After 5 doses of PHENERGAN TABLETS/SUPPOSITORIES symptoms resolved. A diagnosis was provided of viral infection versus reaction to Gardasil. The patient''s mother does not wish for her to continue the Gardasil series. Additional information has been requested.


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