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This is VAERS ID 263354

Case Details

VAERS ID: 263354 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: Massachusetts  
   Days after vaccination:0
Submitted: 2006-09-19
   Days after onset:13
Entered: 2006-09-21
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hormonal contraceptions.
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES0609USA02500

Write-up: Information has been received from a nurse practitioner concerning a 17 year old female with no other pertinent medical history, adverse drug reactions or allergies reported. On 9/6/06, at 3:30pm, the pt was vaccianted IM with the first dose of 0.5ml of HPV rL1 6 11 16 18 VLP vaccine yeast (lot 654540/0800F). Concomitant therapy included an unspecified hormonal contraceptives (also reported as birth control). On 9/6/06, the pt developed a mild seizure right after receiving HPV rL1 6 11 16 18 VLP vaccine yeast. The pt came to and immediately fainted again. The pt sought unspecified medical attention. It was reported that the pt had not eaten anything all day. After eating, the pt felt better. On 9/6/06, the pt had fully recovered from the events. Upon internal review, the mild seizure was considered to be an other important medical event. Additional information has been requested.

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