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This is VAERS ID 269186

Case Details

VAERS ID: 269186 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Oregon  
Vaccinated:2006-10-30
Onset:2006-10-30
   Days after vaccination:0
Submitted: 2006-12-14
   Days after onset:45
Entered: 2006-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Loss of consciousness
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: TYLENOL, LEXAPRO, CLARITIN
Current Illness:
Preexisting Conditions: CONCURRENT CONDITIONS: Depression, Anxiety, Penicillin allergy, Sulfonamide allergy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0611USA03446

Write-up: Information has been received from a nurse practitioner concerning an 18 year old female with low level depression and anxiety and penicillin allergy and sulfonamide allergy who on 30-Oct-2006 was vaccinated intramuscularly in the right deltoid with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot#653978/0955F). Concomitant therapy included escitalopram oxalate (LEXAPRO), loratadine (CLARITIN) acetaminophen (TYLENOL). On 30-Oct-2006, following vaccination, the patient fainted. Unspecified medical attention was sought. Subsequently, the patient recovered and no other symptoms were noted. Additional information has been requested.


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