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This is VAERS ID 271096

Case Details

VAERS ID: 271096 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-01-10
Onset:2007-01-10
   Days after vaccination:0
Submitted: 2007-01-20
   Days after onset:10
Entered: 2007-01-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Blood pressure decreased, Disorientation, Fall, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortly after administration of vaccine, patient loss consciousness, fell from exam table to floor. Was out for 2-3 minutes, was very disoriented and seemed to have difficult time waking. Blood pressure was checked about 5 minutes later when move back to table. Had dropped from initial measurement of 100/70 to 80/40-patient rested for approximately 30 minutes and pressure went back up to 90/70. Patient allowed to leave. Patient has no history of any reactions to injections.


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