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This is VAERS ID 270964

Case Details

VAERS ID: 270964 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Unknown  
Vaccinated:2006-12-20
Onset:2006-12-20
   Days after vaccination:0
Submitted: 2007-01-22
   Days after onset:33
Entered: 2007-01-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0961F / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Syncope, Vaccine positive rechallenge
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Migraine
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0701USA01090

Write-up: Initial and follow-up information has been received from a physician concerning a year old female with no known allergies and a history of "occasional" migraines who on an unspecified date was vaccinated with the first dose of GARDASIL (yeast) (lot number 654540/0800F). Concomitant therapy included hepatitis A virus vaccine (unspecified). Subsequent to the first dose, the patient experienced fainting and "signs of seizure". Clinical outcome was not reported. On 20-DEC-2006 (also reported as 20-DEC-2007), the patient was vaccinated with a second dose of GARDASIL (yeast) (lot number 654389/0961F). On 20-DEC-2006 (also reported as 20-DEC-2007), the patient experienced fainting. Clinical outcome was not reported. Signs of seizure was considered an other important medical event. Additional information has been requested.


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