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This is VAERS ID 263209

Case Details

VAERS ID: 263209 (history)  
Age: 19.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-08-15
Onset:2006-08-15
   Days after vaccination:0
Submitted: 2006-09-14
   Days after onset:30
Entered: 2006-09-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Hyperhidrosis, Tuberculin test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Tuberculin skin test
CDC Split Type: WAES0608USA03961

Write-up: Information has been received from a nurse concerning a 19 year old female with no pertinent medical history or drug reactions allergies who on 8/15/06 was vaccinated IM with the first dose of HPV rL1 6 11 16 18 VLP vaccine yeast (lot 653650/0702F). Concomitant therapy included Menactra. On an unspecified date the pt was given tuberculin purified protein derivative. On 8/15/06, 5 minutes after vaccination with HPV rL1 6 11 16 18 VLP vaccine yeast, the pt became faint. The pt was given water and chocolate as treatment. Subsequently, the pt recovered on 8/15/06. Additional information has been requested. 01/05/2007 Initial and follow-up information has been received from a nurse concerning a 19 year old female patient with no pertinent medical history or drug reactions/allergies who on 15-AUG-2006 at 9:00 AM was vaccinated intramuscularly with the first dose of GARDASIL (lot #653650/0702F). Concomitant therapy included "MENACTRA". On an unspecified date the patient was given tuberculin purified protein derivative. On 15-AUG-2006, within 10 minutes of receiving the vaccination, the patient became very faint and sweaty which lasted for approximately 60 seconds. The patient remained in the office for 45 minutes and was given water and chocolate as treatment. Subsequently, the patient recovered on 15-AUG-2006. No further information is expected.


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