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This is VAERS ID 264959

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 264959
Age:14.0
Gender:Female
Location:Connecticut
Vaccinated:2006-10-16
Onset:2006-10-16
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0741F / 0 RA / IM
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0955F / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Bradycardia, Coma, Heart rate irregular, Pallor, Musculoskeletal stiffness

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.
CDC 'Split Type':

Write-up:Administr4ed 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.


Changed on 12/8/2009

VAERS ID: 264959 Before After
Age:14.0
Gender:Female
Location:Connecticut
Vaccinated:2006-10-16
Onset:2006-10-16
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) HEP A (VAQTA) / MERCK & CO. INC. 0741F / 0 RA / IM
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Bradycardia, Coma, Heart rate irregular, Pallor, Syncope, Urinary incontinence, Musculoskeletal stiffness

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:Administr4ed 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 Gardisil 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 Gardisil). PCP recommended cardiac & neuro w/u. Received cardiac consultation which revealed final dx: probable fainting. Holter monitor was WNL. Awaiting neuro consult.


Changed on 1/5/2010

VAERS ID: 264959 Before After
Age:14.0 13.0
Gender:Female
Location:Connecticut
Vaccinated:2006-10-16
Onset:2006-10-16
Submitted:2006-10-19
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, Pallor, Syncope, Urinary incontinence, Musculoskeletal stiffness

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:Administr4ed Vaqta, Administred VAQTA, then Gardasil, GARDASIL, immediately after Gardasil 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 LOC, tonic/clonic movements & loss of bladder control after received 2nd Gardisil 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 Gardisil). 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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