National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 291585

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 291585
VAERS Form:
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2226AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2492BA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0851U / 1 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Angioedema, Drooling, Lip swelling, Swelling face

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: took Motrin night before
Current Illness: None
Preexisting Conditions: History of hematuria
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.


Changed on 12/8/2009

VAERS ID: 291585 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2226AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2492BA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0851U / 1 RA / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Angioedema, Drooling, Lip swelling, Swelling face

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? Yes, days: 1     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". 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


Changed on 4/7/2010

VAERS ID: 291585 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2226AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2492BA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0851U / 1 RA / SC

Administered by: Private      Purchased by: Public
Symptoms: Angioedema, Drooling, Lip swelling, Swelling face

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? Yes, days: 1     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


Changed on 4/14/2017

VAERS ID: 291585 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2226AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2492BA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0851U / 1 RA / SC

Administered by: Private      Purchased by: Public
Symptoms: Angioedema, Drooling, Lip swelling, Swelling face

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? Yes, days: 1     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


Changed on 9/14/2017

VAERS ID: 291585 Before After
VAERS Form:(blank) 1
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2226AA / 0 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2492BA / 0 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0851U / 1 2 RA / SC

Administered by: Private      Purchased by: Public
Symptoms: Angioedema

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? Yes, days: 1     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


Changed on 2/14/2018

VAERS ID: 291585 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
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

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? Yes, days: 1     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


Changed on 6/14/2018

VAERS ID: 291585 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
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

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? Yes, days: 1     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


Changed on 8/14/2018

VAERS ID: 291585 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
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

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? Yes, days: 1     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


Changed on 9/14/2018

VAERS ID: 291585 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
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

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? Yes, days: 1     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


Changed on 10/14/2018

VAERS ID: 291585 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Michigan
Vaccinated:2007-09-11
Onset:2007-09-13
Submitted:2007-09-21
Entered:2007-09-28
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

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? Yes, days: 1     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

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=291585&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166