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This is VAERS ID 264959

Case Details

VAERS ID: 264959 (history)  
Age: 13.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2006-10-16
Onset:2006-10-16
   Days after vaccination:0
Submitted: 2006-10-19
   Days after onset:3
Entered: 2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0741F / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Bradycardia, Coma, Heart rate irregular, Musculoskeletal stiffness, Pallor, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: Scheduled for cardiac and Neuro follow up. LABS: IgG was only positive for Lyme dx which was considered negative.
CDC Split Type:

Write-up: Administred VAQTA, then GARDASIL, immediately after GARDASIL child became unresponsive, stiff, pale about 30 sex. Child lost bladder control, pulse 46-55 after event, child alert and aware after events. 11/27/06 Received medical records from provider/reporter which reveal patient had LOC, tonic/clonic movements & loss of bladder control after received 2nd GARDASIL vax. HR was 46-55. This was the 3rd episode of LOC within a year (1st after tetanus shot, 2nd after finding a tick & 3rd after 2nd dose of GARDASIL). PCP recommended cardiac & neuro w/u. Received cardiac consultation which revealed final dx: probable fainting. Holter monitor was WNL. Awaiting neuro consult.


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