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This is VAERS ID 290916

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 290916 (history)  
Form: Version .0  
Age: 17.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2007-09-17
Onset:2007-09-17
   Days after vaccination:0
Submitted: 2007-09-19
   Days after onset:2
Entered: 2007-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2758AA / 0 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 1061W / 0 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Pharyngeal oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergic rhinitis, Acne
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced throat swelling, difficulty breathing and chest pain on inspiration just after leaving the office where she had received Gardasil and Adacel. Symptoms gradually resolved over 48 hours. She did not pursue any medical treatment until 48hrs later and did not take any medications.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=290916


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