VAERS ID: |
267443 (history) |
Form: |
Version 1.0 |
Age: |
23.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 2006-10-03 |
Onset: | 2006-10-03 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 42 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Injection site pain,
Loss of consciousness,
Muscle contractions involuntary SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: UNK Current Illness: Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: UNK CDC Split Type: WAES0610USA11404
Write-up: Information has been received from a 23 year old female who on 03-OCT-2006 was vaccinated with a 0.5 mL dose of GARDASIL. The patient reported that the vaccine was given in the front part of the thigh muscle. Subsequently, the muscle contracted and the patient passed out due to pain. Unspecified medical attention was sought. When the patient woke up, she reported that she "felt fine." On 03-OCT-2006, the patient recovered from the events. Additional information is not expected. |