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This is VAERS ID 496656

Case Details

VAERS ID: 496656 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2013-07-12
Onset:2013-07-12
   Days after vaccination:0
Submitted: 2013-07-12
   Days after onset:0
Entered: 2013-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. J000366 / 2 AR / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H021861 / 1 AR / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4594AB / 1 AR / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4432AB / 6 AR / IM

Administered by: Private       Purchased by: Other
Symptoms: Chest discomfort, Dyspnoea, Local swelling, Swelling face, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singulair 10 MG tablet - 1 tab a day; Prevacid - 15 mg - 1 tab a day
Current Illness: None
Preexisting Conditions: T-Cell A.L.L. - Diagnosed 2/08/03; High Dose Chemotherapy beginning 2/9/03 ending 2/18/05; 2003 surgery - implant port-o-cath; 2005 surgery - oral surgery & circumcision correction; 2006 surgery - removal of port-o-cath; 2010 Surgery - Appendectomy; 2011 surgery - Nasal Sinus Surgery blockage and polyp removal; 2003 - diagnosed with a bicuspid aortic valve Allergies - Vacamycin, Elevel; Receives allergy shots for almost all things green that grow outdoors; Appendectomy
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Face and neck swelling, tightness in throat and chest, trouble breathing. Lasted until the hospital gave him an epinephrine shot.


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