Age: 16.0
Sex: F
Vaccine: HPV4, MNQ
Symptoms: Nasopharyngitis, Painful respiration, Pharyngeal oedema, Pneumonia primary atypical, Pulmonary function test normal
Clinical narrative: Initial report received on 28 April 2008 from another manufacturer, report# WAES 0804USA04043.  The initial reporter to this manufacturer had been a health care professional.  Verbatim from the report: "Information has been received from a physician concerning a 16 year old female with no medical history and an allergy to naproxen, who on 17-JAN-2008 was vaccinated IM in one arm with a dose of Gardasil (Lot# 659653/1448U) and a dose of MENACTRA, administered in the other arm.  On approximately 01-FEB-2008, fifteen days post vaccination, the patient developed a rash.  The rash was predominantly on the neck and the face.  The rash was diffuse, macular, itchy, and was hive-like in some areas.  The patient complained of a marked lack of energy and several episodes of wheezing and respiratory discomfort.  On 05-FEB-2008 the patient went to the emergency room because she was experiencing difficulty breathing, headache, and a swelling sensation in the throat.  The patient was diagnosed with allergic reaction and/or exercise induced asthma.  The patient was treated with albuterol and an unspecified steroid.  On 07-FEB-2008 the patient went to the emergency room because she experienced difficulty breathing after taking her inhaler for two days and the steroid for one day.  The patient was diagnosed with atypical pneumonia and treated with ZITHROMAX.  On 15-FEB-2008 the patient was seen for back pain and "choleretic pain."  The shortness of breath had resolved.  The patient's chest x-ray had no change.  The patient had positive convalescent mycoplasma.  On 04-MAR-2008 the patient followed up at the office to recheck the pneumonia and upper respiratory infection, which were resolved.  It was reported that the patient's back pain was 80% better.  The blood counts were normal.  On 07-MAR-2008 the patient was seen by her primary pediatrician.  It was reported that the patient may have used ALEVE during the week for relief of pain.  It was reported that there was no wheezing, lungs were cleared, and the patient was referred to an allergist.  The patient was started on FLOVENT.  On 11-MAR-2008 there was a call to the office for an unspecified reason.  The patient was prescribed an EPIPEN.  On 12-MAR-2008 the patient saw an allergist who said that her pulmonary functions were normal.  The allergist did not think that the patient required respiratory medications.  On 10-APR-2008 the patient came back to the office due to a cold, and complained of a headache, dizziness, and vertigo.  The patient had no other neurological conditions.  The patient had experienced persistent malaise and fatigue since the onset of the rash.  At the time of the report, the patient was not recovered from all events.  No product quality complaint was involved.  Upon internal review the allergic reaction, exercise induce asthma, difficulty breathing, headache, swelling sensation in throat, and atypical pneumonia were considered to be other important medical events.  Additional information has been requested."