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This is VAERS ID 267030

Case Details

VAERS ID: 267030 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-11-15
Onset:2006-11-15
   Days after vaccination:0
Submitted: 2006-11-16
   Days after onset:1
Entered: 2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Disorientation, Dyskinesia, Eye movement disorder, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (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: Adderall XL 30mg q day Depo Provera 150mg q 3 months
Current Illness: none
Preexisting Conditions: NKA none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within a minute of giving injection in rt deltoid, pt experienced pallor, syncope, rolling back of the eyes followed by jerky movements of upper & lower extremities. After 5 seconds, she became responsive, but disoriented to place. Pt stated that she had not eaten much all day.


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