| VAERS ID: |
262096 (history) |
| Form: |
Version 1.0 |
| Age: |
17.0 |
| Gender: |
Female |
| Location: |
New York |
| Vaccinated: | 2006-08-14 |
| Onset: | 2006-08-14 |
| Days after vaccination: | 0 |
| Submitted: |
2006-08-21 |
| Days after onset: | 7 |
| Entered: |
2006-08-25 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0637C / 1 |
RA / IM |
Administered by: Private Purchased by: Private
Symptoms: Asthenia,
Chills,
Cyanosis,
Dizziness,
Pallor,
Pyrexia,
Visual disturbance
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: 1 hr after vaccination, pt reported to feel dizzy, weak, vision went black for a few seconds, got pale with purple lips x 1/2hr. Felt better after drinking OJ. Then got temp 101F and chills x 1 day. |
