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This is VAERS ID 291585

Case Details

VAERS ID: 291585 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Michigan  
Vaccinated:2007-09-11
Onset:2007-09-13
   Days after vaccination:2
Submitted: 2007-09-21
   Days after onset:8
Entered: 2007-09-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2226AA / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2492BA / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0851U / 2 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Angioedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: took Motrin night before
Current Illness: None
Preexisting Conditions: History of hematuria records received 10/15/07-PMH: born 32 weeks premature. Microscopic hematuria secondary from hypercalcemia. Poison ivy dermatitis. Cyst removed
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Child received Tdap, Varicella, Menactra and HPV #1 on 09/11/07. On 09/13/07 she woke up with angioedema of face. There was no difficulty breathing or swallowing. There was no seafood or nut ingestion. She took Motrin the night before and was hospitalized. Received IV steroids and discharged home the next day. 10/15/07-records received for DOS 9/13-9/14/07. DC DX: Angioedema. On day of admission noticed face swollen, with significant swelling of lips and lower face causing disfiguration and drooling. Self treated with Motrin. DC instructions include avoid Motrin and follow up with allergist


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