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This is VAERS ID 271177

Case Details

VAERS ID: 271177 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: New York  
Vaccinated:2007-01-13
Onset:2007-01-13
   Days after vaccination:0
Submitted: 2007-01-24
   Days after onset:11
Entered: 2007-01-25
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 2 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Blood test normal, Chest X-ray normal, Computerised tomogram normal, Convulsion, Electrocardiogram normal, Fall, Fatigue, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
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: chest x-ray 01/13/07 - normal, computed axial 01/13/07 - normal, electrocardiogram 01/13/07 - normal
CDC Split Type: WAES0701USA02032

Write-up: Information has been received from a health professional concerning a 16 year old female who on 11-NOV-2006 was vaccinated intramuscularly with 0.5 ml of the first dose of GARDASIL vaccine (yeast) (lot#654510/0962F) and had no difficulties with the vaccine. On 13-JAN-2007 the patient was given her second dose of GARDASIL vaccine (yeast) (lot# not provided). Within a few moments of receiving the vaccine the patient experienced a seizure, had a very brief loss of consciousness and fell to the floor. The patient was sent to the emergency room for evaluation. The patient was not admitted to the hospital. While in the emergency room she had a CT scan, chest-x-ray and unspecified blood work. The results of these tests were all negative. The patient was seen for a follow-up appointment by the physician on 16-JAN-2007. The patient reported that she was tired, however had not suffered any additional seizures. The patient was referred for a neurology consult. The physician considered the event to be life-threatening. At the time of this report the patient had not recovered from the events. Additional information has been requested.


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