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This is VAERS ID 291932

Case Details

VAERS ID: 291932 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Female  
Location: Massachusetts  
   Days after vaccination:0
Submitted: 2007-10-02
   Days after onset:118
Entered: 2007-10-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Skin irritation, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: therapy unspecified; CREATINE POWDER; PRILOSEC
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA04315

Write-up: Information has been received from a nurse practitioner concerning a 25 year old female with no medical history and no drug allergies, who on 06-JUN-2007 was vaccinated with a first dose of Gardasil (Lot# 658094/0524U). Subsequently, the patient developed local irritation. Concomitant therapy included "creatine" (CREATINE POWDER), "glutamine", "omnijust", and omeprazole (PRILOSEC). On 07-AUG-2007 the patient was vaccinated intramuscularly with a 0.5 mL second dose of Gardasil. On 07-AUG-2007 eight and a half hours after receiving the vaccination the patient developed hives and experienced difficulty breathing. The reaction occurred while she was running outdoors. The patient went to the emergency room and was released after being treated intravenously with diphenhydramine hydrochloride (BENADRYL). The patient recovered on an unspecified date. No product quality complaint was involved. The patient''s difficulty breathing was considered to be life threatening. Additional information has been requested.

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