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This is VAERS ID 290916

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 290916
VAERS Form:
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-09-17
Onset:2007-09-17
Submitted:2007-09-19
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: Unknown
Symptoms: Chest pain, Dyspnoea, Pharyngeal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 48h"rs later and did not take any medications.


Changed on 12/8/2009

VAERS ID: 290916 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-09-17
Onset:2007-09-17
Submitted:2007-09-19
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: Unknown Public
Symptoms: Chest pain, Dyspnoea, Pharyngeal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 48h"rs 48hrs later and did not take any medications.


Changed on 9/14/2017

VAERS ID: 290916 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-09-17
Onset:2007-09-17
Submitted:2007-09-19
Entered:2007-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2758AA / 0 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 1061W / 0 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Pharyngeal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 2/14/2018

VAERS ID: 290916 Before After
VAERS Form:1
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-09-17
Onset:2007-09-17
Submitted:2007-09-19
Entered:2007-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2758AA / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 1061W / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Pharyngeal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 6/14/2018

VAERS ID: 290916 Before After
VAERS Form:1
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-09-17
Onset:2007-09-17
Submitted:2007-09-19
Entered:2007-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2758AA / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 1061W / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Pharyngeal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 8/14/2018

VAERS ID: 290916 Before After
VAERS Form:1
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-09-17
Onset:2007-09-17
Submitted:2007-09-19
Entered:2007-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2758AA / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 1061W / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Pharyngeal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2018

VAERS ID: 290916 Before After
VAERS Form:1
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-09-17
Onset:2007-09-17
Submitted:2007-09-19
Entered:2007-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2758AA / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 1061W / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Pharyngeal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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?IDNUMBER=290916&WAYBACKHISTORY=ON


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