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This is VAERS ID 351067

Case Details

VAERS ID: 351067 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2007-06-14
Onset:2007-06-14
   Days after vaccination:0
Submitted: 2009-07-09
   Days after onset:756
Entered: 2009-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1210U / 2 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / UNK RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1503F / UNK RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Aphonia, Asthenia, Chest discomfort, Cough, Crying, Dizziness, Dyspnoea, Fatigue, Headache, Injection site pain, Injection site swelling, Malaise, Restless legs syndrome
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: LABS: CXR WNL.
CDC Split Type:

Write-up: Coughing, trouble breathing, loss of voice, malaise, crying, headache, chest discomfort, pain at injection site with swelling, dizziness, abdominal pain, weakness, fatigue, restless legs. 7/10/09 Received ER medical records of 5/10/2007. FINAL DX: laryngitis Records reveal patient had chest congestion, dry cough, abnormal taste x 1 week. Seen by PCP & dx w/allergies. OTC allergy med not helpful. Tx w/oral antibiotics & cough syrup. D/C to home w/PCP f/u. 11/23/09 Merdical recs received for date 5/7/07. OV for c/o sore throat. DX: postnasal drip. OV 5/14/07 c/o sore throat f/u ER visit. DX: postnasal drip.


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