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This is VAERS ID 269221

Case Details

VAERS ID: 269221 (history)  
Form: Version 1.0  
Gender: Female  
Location: Arizona  
   Days after vaccination:0
Submitted: 2006-12-14
   Days after onset:36
Entered: 2006-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 1 UN / -

Administered by: Private       Purchased by: Private
Symptoms: Blood pressure decreased, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (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: UNK
Current Illness:
Preexisting Conditions: Allergic reaction to antibiotics.
Diagnostic Lab Data: Blood pressure 11/08/06 low.
CDC Split Type: WAES0611USA06802

Write-up: Information has been received from a health professional concerning a female patient with an allergy to amoxicillin and clavulanate potassium who on 08 Nov 2006 at 11:00 AM was vaccinated in the right deltoid with the first dose of HPV vaccine. (Lot #654540/0800F) There was no illnesses at the time of vaccination. On 08 Nov 2006, at 1PM, following vaccination, the patient became lightheaded. Then while walking out of the office, the patient had a syncopal episode. It was reported that there was no detectable seizure activity and the patient was not post ictal. The patient''s blood pressure was low, however not documented. The patient subsequently recovered with elevation of her feet and after five minutes, the patient was sent home. Additional information has been requested.

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