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This is VAERS ID 262872

Case Details

VAERS ID: 262872 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Florida  
Vaccinated:2006-09-02
Onset:2006-09-02
   Days after vaccination:0
Submitted: 2006-09-02
   Days after onset:0
Entered: 2006-09-12
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 08007 / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Syncope, Tonic clonic movements
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: vital signs stable
CDC Split Type:

Write-up: Immediately after vaccine administration patient had syncopal episode with tonic posturing fell from table. Responded with gentle stimulation versus normal 5 minutes post regaining full consciousness.


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