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This is VAERS ID 297532

Case Details

VAERS ID: 297532 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: Missouri  
Vaccinated:2007-10-19
Onset:2007-10-19
   Days after vaccination:0
Submitted: 2007-11-20
   Days after onset:32
Entered: 2007-11-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal oedema, Rash
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN; DIPENTUM; PRILOSEC; SEROQUEL; EFFEXOR
Current Illness: Depression; Anxiety; Gastrooesophageal reflux disease; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0711USA02887

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with depression, anxiety and gastroesophageal reflux disease and a history of drug hypersensitivity to PREDNISONE, ZOLOFT and "BENREX" who on 19-OCT-2007 was vaccinated intramuscularly with a 0.5ml dose of Gardasil (lot# 657621/0387U). Concomitant therapy included PRILOSEC, DIFENTUM, EFFEXOR, SEROQUEL and ORTHO TRI-CYCLEN. On 19-OCT-2007, the patient experienced difficulty breathing with possible throat swelling post vaccination. The patient also had arm pain and bumps on arm (not specific). The patient was treated in the emergency room with VISTARIL and ULTRAM and was hospitalized overnight. Additional information has been requested.


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