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From the 1/7/2022 release of VAERS data:

This is VAERS ID 366912

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Case Details

VAERS ID: 366912 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Foreign  
Vaccinated:2009-09-28
Onset:2009-09-28
   Days after vaccination:0
Submitted: 2009-11-12
   Days after onset:45
Entered: 2009-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA058BF / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Hypersensitivity, Panic reaction, Paraesthesia oral, Rash macular, Respiratory rate increased, Throat irritation
SMQs:, Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: Allergic reaction
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: B0601161A

Write-up: This case was reported by the regulatory authority (Regulatory Agency# GB-MHRA-ADR 20514478) and described the occurrence of systemic allergic reaction in a 15-year-old female subject who was vaccinated with (CERVARIX, GlaxoSmithKline). The subject''s medical history included an allergic reaction. The subject had not had any reactions since she was 4 years and 6 months old. On 28 September 2009, the subject received a single dose of CERVARIX (intramuscular, Batch number AHPVA058BF). On 28 September 2009, within 5 minutes after the vaccination with CERVARIX, the subject developed a blotchy face, tingling in mouth, throat and tongue. She then panicked and had rapid breathing. The regulatory authority reported that the events were life threatening. An ambulance was called, and the young person was asked to lie down, and was calmed with breathing exercises. Adrenaline on stand by but not administered. At the time of reporting the events were improved. Verbatim Text: Young person had an unknown allergy, but had not had any reaction since she was 4 yrs and 6 months old. Within 5 minutes of vaccination, the young person developed blotchy face, tingling in mouth, throat and tongue. She then panicked and had rapid breathing. Ambulance called, young person asked to lie down, and calmed with breathing exercises. Adrenaline on stand by but not administered.


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