National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 291585

(NOTE: This result is from the 12/31/2007 version of the VAERS database)

Case Details

VAERS ID: 291585 (history)  
Form: Version .0  
Age: 11.0  
Sex: Female  
Location: Michigan  
Vaccinated:2007-09-11
Onset:2007-09-13
   Days after vaccination:2
Submitted: 2007-09-21
   Days after onset:8
Entered: 2007-09-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2226AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2492BA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0851U / 1 RA / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Angioedema, Drooling, Lip swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: took Motrin night before
Current Illness: None
Preexisting Conditions: History of hematuria
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Child received Tdap, Varicella, Menactra and HPV #1 on 09/11/07. On 09/13/07 she woke up with angioedema of face. There was no difficulty breathing or swallowing. There was no seafood or nut ingestion. She took Motrin the night before and was hospitalized". Received IV steroids and discharged home the next day.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20071231&IDNUMBER=291585


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166